Skip to main content
SpringerLink
Log in

Endoscopic Optic Nerve Decompression for Direct Traumatic Optic Neuropathy : Our 10 Years Experience

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Traumatic optic neuropathy (TON) can be classified into direct or indirect types. Direct optic injury usually results from optic nerve avulsion ,laceration or compression by fracture, fracture segment impingement or a resultant hematoma. Indirect optic injury is caused by increased intracanalicular pressure resulting in ischemia and disruption of neurofeedback channels. The prognosis of TON is usually quite poor. To date, no standardized treatment protocol has been developed for TON. In this study we are assessing the visual improvement in patients with direct TON who underwent endoscopic optic nerve decompression in the last 10 years. A retrospective study of 32 cases of optic nerve decompression for direct TON in the last 10 years. Preoperative and postoperative visual assessment were done and followed up for 3 months. There was complete improvement in vision in 17% of patients when optic nerve decompression was done within 72 h of trauma; whereas 31% cases had only partial improvement when done between 3 and 7 days. And there was no improvement when done after 7 days. Endoscopic optic nerve decompression is a minimally invasive surgery for direct traumatic optic neuropathy; with minimal or no complications when done by an experienced ENT surgeon. Other important prognostic factors include timing of surgery and preoperative visual status.

Highlights

  • Traumatic optic neuropathy (TON); mainly classified into direct and indirect types, do not have a well established treatment protocol till now.

  • Direct type of optic neuropathy is caused by injury to optic nerve, by fracture lines or segments.

  • TON not resolving with medical decompression is taken up for endoscopic optic nerve decompression as early as possible; preferably within 72 h.

  • Pre operative visual status is one of the main prognostic factor along with timing of surgery; patients with at least perception of light fared way better than those with no perception of light.

  • Patients in whom EOND was done within 72 h had better visual improvement than those in whom intervention was done after 72 h.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Richard LA, William RP, Cordell EG Optic Nerve Blindness Following Blunt Forehead Trauma. Ophthalmology.1982;89: 445 – 55. https://doi.org/10.1016/S0161-6420(82)34769-7

  2. Kallela I, Hyrkas T, Paukku P, lizuka T, Lindqvist C (1994) Blindness after maxillofacial blunt trauma: Evaluation of candidates for optic nerve decompression surgery. J Craniomaxillofac Surg 22:220–225

    Article  CAS  Google Scholar 

  3. Tandon V, Mahapatra A (2017) Current Management of Optic Nerve Injury. Indian J Neurosurg 06:083–085. https://doi.org/10.1055/s-0037-1606314

    Article  Google Scholar 

  4. Kountakis SE, Maillard AA, El-Harazi SM, Longhini L, Urso RG (2000) Endoscopic optic nerve decompression for traumatic blindness. Otolaryngol Head Neck Surg. Jul;123(1 Pt 1):34 – 7. https://doi.org/10.1067/mhn.2000.106007. PMID: 10889478.

  5. Kilian SB, Nicolas F, Hermann B, Lutz H, Michael B (2006) Visual Acuities “Hand Motion” and “Counting Fingers” Can Be Quantified with the Freiburg Visual Acuity Test. Invest Ophthalmol Vis Sci 47(3):1236–1240. https://doi.org/10.1167/iovs.05-0981

    Article  Google Scholar 

  6. Seiff SR (1992) Trauma and the optic nerve. Ophthalmol Clin North Am 5:389–394

    Google Scholar 

  7. Luxenberger WC, Stammberger H, Jebeles JA, Walch C, Endoscopic Optic Nerve Decompression (1998) The Graz Experience Laryngoscope 108:873–882. https://doi.org/10.1097/00005537-199806000-00016

    Article  CAS  Google Scholar 

  8. Dhaliwal SS, Sowerby LJ, Rotenberg BW (2016 Jun) Timing of endoscopic surgical decompression in traumatic optic neuropathy: a systematic review of the literature. Int Forum Allergy Rhinol 6(6):661–667. https://doi.org/10.1002/alr.21706 Epub 2016 Jan 19. PMID: 26782715

  9. Mabuchi F, Aihara M, Mackey MR, Lindsey JD, Weinreb RN (2003) Oct;44(10):4321-30 Optic nerve damage in experimental mouse ocular hypertension. Invest Ophthalmol Vis Sci. https://doi.org/10.1167/iovs.03-0138. PMID: 14507876

  10. Levin LA (1999) Intrinsic survival mechanisms for retinal ganglion cells. Eur J Ophthalmol. Jan-Mar;9 Suppl 1:S12-6. PMID: 10230600

  11. Di Somma A, Andaluz N, Gogela SL, Cavallo LM, Keller JT, Prats-Galino A et al (2017) May Surgical Freedom Evaluation During Optic Nerve Decompression: Laboratory Investigation. World Neurosurg. ;101:227–235. https://doi.org/10.1016/j.wneu.2017.01.117. Epub 2017 Feb 21. PMID: 28232210.

  12. Di Somma A, Cavallo LM, de Notaris M, Solari D, Topczewski TE, Bernal-Sprekelsen M et al (2017 Jul) Endoscopic endonasal medial-to-lateral and transorbital lateral-to-medial optic nerve decompression: an anatomical study with surgical implications. J Neurosurg 127(1):199–208. https://doi.org/10.3171/2016.8.JNS16566 Epub 2016 Oct 28. PMID: 27791520

  13. Wang EW, Zanation AM, Gardner PA, Schwartz TH, Eloy JA, Adappa ND et al (2019) ICAR: endoscopic skull-base surgery. Int Forum Allergy Rhinol 9:S145–S365. https://doi.org/10.1002/alr.22326

    Article  Google Scholar 

  14. Volk GF, Pantel M, Guntinas-Lichius O (2010) Modern concepts in facial nerve reconstruction. Head Face Med. https://doi.org/10.1186/1746-160X-6-25. 6:25. Published 2010 Nov 1

  15. Thaker A, Tandon DA, Mahapatra AK (2009) Surgery for optic nerve injury: should nerve sheath incision supplement osseous decompression? Skull Base 19(4):263–271. https://doi.org/10.1055/s-0028-1114299

    Article  Google Scholar 

  16. Steinsapir KD, Goldberg RA (2011 Jun) Traumatic optic neuropathy: an evolving understanding. Am J Ophthalmol 151(6):928–933e2. https://doi.org/10.1016/j.ajo.2011.02.007 Epub 2011 May 6. PMID: 21529765

Download references

Author information

Authors and Affiliations

  1. Department of otorhinolaryngology & head and neck surgery, Pushpagiri institute of medical sciences and research centre, Tiruvalla, Kerala, India

    Vivek Sasindran & Mithra Sara John

Authors
  1. Vivek Sasindran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mithra Sara John
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mithra Sara John.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sasindran, V., John, M.S. Endoscopic Optic Nerve Decompression for Direct Traumatic Optic Neuropathy : Our 10 Years Experience. Indian J Otolaryngol Head Neck Surg 74, 594–599 (2022). https://doi.org/10.1007/s12070-022-03194-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-022-03194-y

Keywords

Search

Navigation