Abstract
BackgroundTo evaluate the safety and outcomes of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) for children with indirect traumatic optic neuropathy (ITON).MethodsFrom July 1st, 2008 to July 1st, 2015, 62 children diagnosed with ITON who underwent ETOCD were reviewed. Main outcome measure was improvement in visual acuity after treatment.ResultsAltogether 62 children (62 eyes) with a mean age of 11.26 ± 4.14 years were included. Thirty-three (53.2%) of them had residual vision before surgery while 29 (46.8%) had no light perception (NLP). The overall visual acuity improvement rate after surgery was 54.84%. The improvement rate of patients with residual vision (69.70%) was significant higher than that of patients with no light perception (NLP) (37.9%) (P = 0.012). However, no significant difference was shown among patients with different residual vision (P = 0.630). Presence of orbital and/ or optic canal fracture and hemorrhage within the post-ethmoid and/or sphenoid sinus resulted in poor postoperative visual acuity, duration of presenting complaints did not affect final visual acuity or did not effect outcomes. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome. Three patients developed cerebrospinal fluid rhinorrhea and one encountered cavernous sinus hemorrhage during surgery. No other severe complications were observed.ConclusionChildren with residual vision had better postoperative visual prognosis and benefited more from ETOCD than children with NLP. Intervention performed in children presenting even after 7 days from the injury did not influence the final visual outcome, however, this needs to be reassessed in children presenting long after the injury.Treatment should still be recommended even for cases of delayed presentation to hospital.
Highlights
To evaluate the safety and outcomes of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) for children with indirect traumatic optic neuropathy (ITON)
The treatment protocol of ITON is relatively well defined in adult, suggesting endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) is feasible way to improve outcome [2, 4, 5]
ITON was diagnosed based on severe reduction or loss in visual acuity (VA) accompanied by a relative afferent pupillary defect (RAPD) after a closed head injury
Summary
To evaluate the safety and outcomes of endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) for children with indirect traumatic optic neuropathy (ITON). Traumatic optic neuropathy (TON) is a relatively rare but potentially severe complication of head injury. The treatment protocol of ITON is relatively well defined in adult, suggesting endoscopic trans-ethmosphenoid optic canal decompression (ETOCD) is feasible way to improve outcome [2, 4, 5]. Its application to children is far from agreement, with only a few studies available. In this case series, we set out to explore the outcome of ETOCD for children with ITON
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