Endoscopic Endonasal Optic Nerve Decompression for Benign Pathology of the Optic Canal

Abstract

Objective: Optic nerve decompression for benign pathology has traditionally been accomplished with open transcranial approaches. Advances in techniques and instrumentation have enabled endoscopic endonasal surgery (EES) to be used in select cases. Study Design: Retrospective chart review. Methods: Patients with intrinsic or extrinsic compression of the canalicular segment of the optic nerve that underwent EES between 2010 and 2013 were studied. Those with malignant pathology, traumatic optic neuropathy, suprasellar meningiomas, or who underwent a concurrent transcranial approach were excluded. The primary outcome assessed was visual acuity. Results: Seven patients and eight optic nerves were decompressed via EES. Diagnoses included fibrous dysplasia (n = 4), optic nerve sheath meningioma (n = 2), and orbital apex meningioma (n = 1). Decreased visual acuity was noted in six patients preoperatively while the remaining patient demonstrated an afferent pupillary defect. All patients had improvement in visual acuity; five nerves demonstrated normal vision postoperatively. No major complications were identified. Conclusions: EES for optic nerve decompression appears to be a safe and effective treatment for patients with benign pathology compression the optic nerve. Further studies are required to confirm these findings as well as identify patient selection parameters for an open versus an endoscopic approach.