Endoscopic Endonasal Optic Nerve Decompression for Fibrous Dysplasia
10 January 2016
27 March 2016
02 June 2016 (online)
Objective To evaluate visual outcomes and potential complications for optic nerve decompression using an endoscopic endonasal approach (EEA) for fibrous dysplasia.
Design Retrospective chart review of patients with fibrous dysplasia causing extrinsic compression of the canalicular segment of the optic nerve that underwent an endoscopic endonasal optic nerve decompression at the University of Pittsburgh Medical Center from 2010 to 2013.
Main Outcome Measures The primary outcome measure assessed was best-corrected visual acuity (BCVA) with secondary outcomes, including visual field testing, color vision, and complications associated with the intervention.
Results A total of four patients and five optic nerves were decompressed via an EEA. All patients were symptomatic preoperatively and had objective findings compatible with compressive optic neuropathy: decreased visual acuity was noted preoperatively in three patients while the remaining patient demonstrated an afferent pupillary defect. BCVA improved in all patients postoperatively. No major complications were identified.
Conclusion EEA for optic nerve decompression appears to be a safe and effective treatment for patients with compressive optic neuropathy secondary to fibrous dysplasia. Further studies are required to identify selection criteria for an open versus an endoscopic approach.
- 1 Dumitrescu CE, Collins MT. McCune-Albright syndrome. Orphanet J Rare Dis 2008; 3: 12
- 2 Weinstein LS, Shenker A, Gejman PV, Merino MJ, Friedman E, Spiegel AM. Activating mutations of the stimulatory G protein in the McCune-Albright syndrome. N Engl J Med 1991; 325 (24) 1688-1695
- 3 Bianco P, Riminucci M, Majolagbe A , et al. Mutations of the GNAS1 gene, stromal cell dysfunction, and osteomalacic changes in non-McCune-Albright fibrous dysplasia of bone. J Bone Miner Res 2000; 15 (1) 120-128
- 4 Bianco P, Robey Pg. Diseases of bone and the stromal cell lineage. J Bone Miner Res 1999; 14 (3) 336-341
- 5 Valentini V, Cassoni A, Marianetti TM, Terenzi V, Fadda MT, Iannetti G. Craniomaxillofacial fibrous dysplasia: conservative treatment or radical surgery? A retrospective study on 68 patients. Plast Reconstr Surg 2009; 123 (2) 653-660
- 6 DeKlotz TR, Kim HJ, Kelly M, Collins MT. Sinonasal disease in polyostotic fibrous dysplasia and McCune-Albright Syndrome. Laryngoscope 2013; 123 (4) 823-828
- 7 Cutler CM, Lee JS, Butman JA , et al. Long-term outcome of optic nerve encasement and optic nerve decompression in patients with fibrous dysplasia: risk factors for blindness and safety of observation. Neurosurgery 2006; 59 (5) 1011-1017 , discussion 1017–1018
- 8 Lee JS, FitzGibbon E, Butman JA , et al. Normal vision despite narrowing of the optic canal in fibrous dysplasia. N Engl J Med 2002; 347 (21) 1670-1676
- 9 Amit M, Collins MT, FitzGibbon EJ, Butman JA, Fliss DM, Gil Z. Surgery versus watchful waiting in patients with craniofacial fibrous dysplasia—a meta-analysis. PLoS ONE 2011; 6 (9) e25179
- 10 Plotkin H, Rauch F, Zeitlin L, Munns C, Travers R, Glorieux FH. Effect of pamidronate treatment in children with polyostotic fibrous dysplasia of bone. J Clin Endocrinol Metab 2003; 88 (10) 4569-4575
- 11 DiMeglio LA. Bisphosphonate therapy for fibrous dysplasia. Pediatr Endocrinol Rev 2007; 4 (Suppl. 04) 440-445
- 12 Luxenberger W, Stammberger H, Jebeles JA, Walch C. Endoscopic optic nerve decompression: the Graz experience. Laryngoscope 1998; 108 (6) 873-882
- 13 Dumont AS, Boulos PT, Jane Jr JA, Ellegala DB, Newman SA, Jane Sr JA. Cranioorbital fibrous dysplasia: with emphasis on visual impairment and current surgical management. Neurosurg Focus 2001; 10 (5) E6
- 14 Papay FA, Morales Jr L, Flaharty P , et al. Optic nerve decompression in cranial base fibrous dysplasia. J Craniofac Surg 1995; 6 (1) 5-10 , discussion 11–14
- 15 Chen YR, Breidahl A, Chang CN. Optic nerve decompression in fibrous dysplasia: indications, efficacy, and safety. Plast Reconstr Surg 1997; 99 (1) 22-30 , discussion 31–33
- 16 Locatelli M, Caroli M, Pluderi M , et al. Endoscopic transsphenoidal optic nerve decompression: an anatomical study. Surg Radiol Anat 2011; 33 (3) 257-262
- 17 Li J, Wang J, Jing X, Zhang W, Zhang X, Qiu Y. Transsphenoidal optic nerve decompression: an endoscopic anatomic study. J Craniofac Surg 2008; 19 (6) 1670-1674
- 18 Robinson D, Wilcsek G, Sacks R. Orbit and orbital apex. Otolaryngol Clin North Am 2011; 44 (4) 903-922 , viii
- 19 Kong D-S, Shin HJ, Kim HY , et al. Endoscopic optic canal decompression for compressive optic neuropathy. J Clin Neurosci 2011; 18 (11) 1541-1545
- 20 Pletcher SD, Metson R. Endoscopic optic nerve decompression for nontraumatic optic neuropathy. Arch Otolaryngol Head Neck Surg 2007; 133 (8) 780-783
- 21 Sia DIT, Chan WO, Wormald PJ, Davis G, Selva D. Decompression of benign orbital apex lesion via medial endoscopic approach. Orbit 2012; 31 (5) 344-346
- 22 Bulters DO, Shenouda E, Evans BT, Mathad N, Lang DA. Visual recovery following optic nerve decompression for chronic compressive neuropathy. Acta Neurochir (Wien) 2009; 151 (4) 325-334
- 23 Sleep TJ, Hodgkins PR, Honeybul S, Neil-Dwyer G, Lang D, Evans B. Visual function following neurosurgical optic nerve decompression for compressive optic neuropathy. Eye (Lond) 2003; 17 (5) 571-578
- 24 Jacob M, Raverot G, Jouanneau E , et al. Predicting visual outcome after treatment of pituitary adenomas with optical coherence tomography. Am J Ophthalmol 2009; 147 (1) 64-70.e2
- 25 Miller NR. Predicting visual recovery following optic nerve decompression for chronic optic neuropathy. Acta Neurochir (Wien) 2009; 151 (12) 1729
- 26 Moon CH, Hwang SC, Ohn Y-H, Park TK. The time course of visual field recovery and changes of retinal ganglion cells after optic chiasmal decompression. Invest Ophthalmol Vis Sci 2011; 52 (11) 7966-7973
- 27 Metson R, Pletcher SD. Endoscopic orbital and optic nerve decompression. Otolaryngol Clin North Am 2006; 39 (3) 551-561 , ix