The Endoscopic Endonasal Transethmoido-Sphenoidal Optic Nerve Decompression: Surgical Technique, Case Series, and Potential Indications

Introduction: Among classical indications of endoscopic endonasal skull base surgery (sellar and suprasellar pathologies), rare reports described the possibility of decompressing the optic canal from below. These cases involved traumatic optic neuropathies, Graves' orbitopathies, and fibrous dysplasia. We detail the surgical nuances of the optic nerve and orbital apex decompression. Methods: The authors reviewed their series of endoscopic endonasal skull base surgeries from 2006 to 2012 to identify all cases that underwent optic nerve decompression. A review of the biomedical databases was also performed with the keywords “endoscopic endonasal,” “optic nerve,” “optic canal,” “decompression,” “orbital apex.” Results: Nine cases of endoscopic endonasal optic nerve decompression were identified among more than 1,000 cases of endoscopic endonasal skull base surgeries. All patients underwent decompression because of a recent optic neuropathy. Total 70% of patients improved either on visual acuity and/or visual field. Six patients harbored orbital apex meningiomas with optic canal extensions, while there was a neuroma, an ossifying fibroma, and an inflammatory pseudotumor. Conclusion: Our study showed the usefulness of the endoscopic endonasal decompression of the optic nerve in selected cases, in a minimally invasive manner. Future larger series will precise clear indications according to the underlying pathology and define the accurate timing for surgery before optic atrophy.