21 - Endoscopic Optic Nerve Decompression: Intracanalicular Portion

Abstract

The introduction of the endoscope has revolutionized the approach to the optic canal. Traditionally, the optic nerve was decompressed via a transcranial approach. Over the past two decades, this method has evolved into novel techniques characterized by a purely endoscopic endonasal transsphenoidal approach. The increased use of this approach has established several advantages, such as superior visualization of infrachiasmatic perforators, access to the inferomedial portion of the optic canal, and greater visual outcomes. Although the endoscopic endonasal approach has the potential for higher rates of cerebrospinal fluid leaks, the use of a vascularized pedicle nasoseptal flap has provided a valuable solution. Further integration of this approach into surgical practice will solidify its advantageous role in optic nerve decompression.