Endoscopic Optic Nerve Decompression

  • Emel Çadallı Tatar
  • Hakan Korkmaz


Traditionally, optic nerve decompression was performed via craniotomy, extranasal transethmoidal, transorbital, transantral, and intranasal microscopic approaches. Nowadays, transnasal endoscopic approach has been preferred for optic nerve decompression because this surgical approach provides excellent visualization, decreased morbidity by avoidance of external surgeries, preservation of important structures like olfaction, or developing teeth in children. Although this surgery is performed most frequently for post-traumatic optic neuropathy, compression on optic nerve from skull base tumors or fibro-osseous lesions seem most favorable indications. Indications for optic nerve decompression include traumatic optic neuropathy (TON), fibro-osseous lesions, skull base tumors, Graves’ ophthalmopathy associated with optic neuropathy, and idiopathic intracranial hypertension. TON is the most frequent indication for optic nerve decompression. TON means acute injury to the optic nerve due to craniofacial trauma. Approximately, 5% of severe head injuries affect some part of visual tract. Up to 1.5% cases of them have TON. The most common cause of optic neuropathy in pediatric age group is falls, whereas it is motor vehicle accidents in adults [6]. Otolaryngol Clin North Am. 44:903–22, 2011. Although it is not a common issue, TON should be evaluated in all cases of head injuries due to its devastating morbidity for the patient. In this chapter, we aimed to focus on the indications, surgical technique, and complications of endoscopic optic nerve decompression. Also we aimed to discuss controversial subjects as decision-making or timing of the surgical intervention.


Endoscopic optic nerve decompression Traumatic optic neuropathy Fibro-osseous lesions Skull base tumors Graves’ ophthalmopathy associated with optic neuropathy İdiopathic intracranial hypertension 


  1. 1.
    Metson R, Pletcher SD. Endoscopic orbital and optic nerve decompression. Otolaryngol Clin North Am. 2006;39(3):551–61. ix. ReviewCrossRefGoogle Scholar
  2. 2.
    Pletcher SD, Metson R. Endoscopic optic nerve decompression for nontraumatic optic neuropathy. Arch Otolaryngol Head Neck Surg. 2007;133(8):780–3.CrossRefGoogle Scholar
  3. 3.
    Lang J. Anatomy of optic nerve decompression and anatomy of the orbit and adjacent skull base in surgical anatomy of the skull base. Berlin: Springer; 1989.Google Scholar
  4. 4.
    Moore KL. Clinically oriented anatomy. Baltimore: Williams & Wilkins; 1992.Google Scholar
  5. 5.
    Bersani TA, Meeker AR, Sismanis DN, Carruth BP. Pediatric and adult vision restoration after optic nerve sheath decompression for idiopathic intracranial hypertension. Orbit. 2016:1–8.Google Scholar
  6. 6.
    Robinson D, Wilcsek G, Sacks R. Orbit and orbital apex. Otolaryngol Clin North Am. 2011;44:903–22.CrossRefGoogle Scholar
  7. 7.
    Yu-Wai-Man P, Griffiths PG. Steroids for traumatic optic neuropathy. Cochrane Database Syst Rev. 2007;(1):CD006032.Google Scholar
  8. 8.
    Anderson RL, Panje WR, Gross CE. Optic nerve blindness following blunt forehead trauma. Ophthalmology. 1982;89:445.CrossRefGoogle Scholar
  9. 9.
    Emanuelli E, Bignami M, Digilio E, Fusetti S, Volo T, Castelnuovo P. Post-traumatic optic neuropathy: our surgical and medical protocol. Eur Arch Otorhinolaryngol. 2015;(11):3301–9.CrossRefGoogle Scholar
  10. 10.
    Levin LA, Joseph MP, Rizzo JF 3rd, et al. Optic canal decompression in indirect optic nerve trauma. Ophthalmology. 1994;101:566.CrossRefGoogle Scholar
  11. 11.
    Rajiniganth MG, Gupta AK, Gupta A, et al. Traumatic optic neuropathy: visual outcome following combined therapy protocol. Arch Otolaryngol Head Neck Surg. 2003;129:1203.CrossRefGoogle Scholar
  12. 12.
    Pletcher SD, Sindwani R, Metson R. Endoscopic orbital and optic nerve decompression. Otolaryngol Clin North Am. 2006;39:943.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Emel Çadallı Tatar
    • 1
  • Hakan Korkmaz
    • 2
  1. 1.Department of OtorhinolaryngologyUniversity of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research HospitalAnkaraTurkey
  2. 2.Medical Faculty, Department of OtorhinolaryngologyYıldırım Beyazıt UniversityAnkaraTurkey

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