scholarly journals Endoscopic optic nerve decompression in traumatic optic neuropathy: our experience in a tertiary care centre

2021 ◽  
Author(s):  
Bincy Joseph ◽  
Sapna S. Nambiar ◽  
K. Ramachandran ◽  
Suma Radhakrishnan
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
High Dose ◽  
Time Interval ◽  
Traumatic Optic Neuropathy ◽  
High Dose Steroid ◽  
Nerve Decompression ◽  
Prompt Treatment ◽  
Optic Nerve Decompression

<p><strong>Background: </strong>Traumatic optic neuropathy (TON) a vision threatening disorder requires early diagnosis and prompt treatment. High dose steroid injections, optic nerve decompression or combined therapy are the available current treatment options. This study aims to determine the visual outcome with transnasal endoscopic optic nerve decompression in patients with TON having no improvement in vision despite high dose steroids.</p><p><strong>Methods:</strong> A prospective study was conducted at the department of ENT, government medical college Kozhikode; on patients who presented with loss of vision following history of trauma. All patients suspected of compressive optic neuropathy received injection methyl prednisolone (30 mg/kg/day) with assessment of vision and HRCT scan. Patients with deterioration or no improvement in vision despite high steroid therapy were taken up for trans-nasal endoscopic optic nerve decompression.</p><p><strong>Results:</strong> In our study 19 patients with TON underwent trans-nasal endoscopic optic nerve decompression. 11(57.9%) patients had improvement of vision, 7 (36.8%) patients had no improvement of vision and 1 (5.3%) patient had worsening of vision. The visual improvement was seen in 8 (80%) patients when treatment was initiated within 7 days and in only 3(33.3%) patients when treatment was initiated after 7 days. The visual acuity at presentation and time interval between trauma and intervention are factors that determine better visual outcomes.</p><p><strong>Conclusions:</strong> The decreased visual acuity in TON requires prompt treatment. High dose steroid must be started at once when it is suspected or diagnosed. The timely surgical intervention with trans-nasal endoscopic optic nerve decompression is a relatively safe and effective technique enabling better visual prognosis.</p>

Outcomes of Steroid Therapy in Combination with Endoscopic Optic Nerve Decompression Surgery for Direct Traumatic Optic Neuropathy: A Case-Series

2021 ◽  
Vol 104 (7) ◽  
pp. 1166-1171
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
Poor Prognosis ◽  
Combined Treatment ◽  
Treatment Protocol ◽  
Case Series ◽  
Light Perception ◽  
Traumatic Optic Neuropathy ◽  
Nerve Decompression

Background: Direct traumatic optic neuropathy (TON) carries a poor prognosis. However, the outcome of this injury is diverse and is related to time to treatment and treatment protocol. Objective: To evaluate the outcomes of the combined treatment protocol in patients with direct TON. Materials and Methods: The authors retrospectively reviewed the medical records of patients between January 2015 and August 2019. Main outcome was visual acuity (VA) improvement after the treatment. Results: Thirteen patients (15 eyes) were included. The mean age was 38.61 years with a range of 13 to 65 years. Initial VA varied from no light perception (NPL) in seven eyes of six patients, light perception (PL) in one eye, counting fingers in two eyes, 20/200 in three eyes, and 20/60 in two eyes. Average timing to treatment was 2.8 days (range 0 to 7 days). There were no side effects of high-dose corticosteroids treatment in all patients. During a follow-up period of three months, six of 13 patients (46.1%) had VA improvement. Conclusion: Despite poor prognosis of direct TON, the combined treatment protocol provides a favorable successful rate with most patients on having stable vision, and some having visual improvement from reducing intracanalicular pressure of the optic nerve. Keywords: Endoscopic optic nerve decompression; Traumatic optic neuropathy; Visual acuity; Case series

The effect of steroids in combination With optic nerve decompression surgery in traumatic optic neuropathy

2013 ◽  
Vol 123 (5) ◽  
pp. 1082-1086 ◽  
Author(s):  
Thorsten Ropposch ◽  
Bernhard Steger ◽  
Cem Meço ◽  
Martin Emesz ◽  
Herbert Reitsamer ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Decompression Surgery ◽  
Traumatic Optic Neuropathy ◽  
Nerve Decompression ◽  
Optic Nerve Decompression ◽  
Nerve Decompression Surgery

Extradural Anterior Clinoidectomy as an Alternative Approach for Optic Nerve Decompression: Anatomic Study and Clinical Experience

2006 ◽  
Vol 59 (suppl_4) ◽  
pp. ONS-253-ONS-262 ◽  
Author(s):  
Yang Yang ◽  
Hongjie Wang ◽  
Yi Shao ◽  
Zenghua Wei ◽  
Shugan Zhu ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Optic Canal ◽  
Falciform Ligament ◽  
Traumatic Optic Neuropathy ◽  
Pterional Craniotomy ◽  
Anterior Clinoidectomy ◽  
Nerve Decompression ◽  
Optic Nerve Decompression ◽  
Alternative Approach

Abstract OBJECTIVE: We introduce pterional craniotomy extradural anterior clinoidectomy as a new alternative approach for optic nerve decompression in patients with traumatic optic neuropathy. METHODS: Intracranial structures pertinent to pterional craniotomy extradural anterior clinoidectomy were carefully studied in 10 dry craniums and 10 cranial bases with dura mater. Important parameters of these structures were measured. Stepwise dissections simulating pterional craniotomy extradural anterior clinoidectomy were performed in 20 cadaver heads bilaterally. Pterional craniotomy extradural anterior clinoidectomy was then applied to 12 patients (13 eyes) with traumatic optic neuropathy and severe visual dysfunction. RESULTS: The anatomic features and their variations of optic canal, ophthalmic artery, falciform ligament, and Zinn's ring (annular tendon) were studied and measured in detail. Extensive opening of the optic canal and optic nerve sheath was successfully achieved in all 12 patients without major surgical complications. Significant visual acuity improvement occurred in eight (nine eyes) out of our 12 patients after surgery. The surgical techniques and advantages of pterional craniotomy extradural anterior clinoidectomy for optic nerve decompression are presented and discussed in detail. @@CONCLUSION:@@ Pterional craniotomy extradural anterior clinoidectomy is a promising new alternative approach for optic nerve decompression in patients with traumatic optic neuropathy.

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