Decompression of the Optic Nerve in Cases of Residual Vision—Are There Still Chances in Delayed Surgery?

Introduction: The question of whether a decompression of the optic nerve should be performed after skull trauma is still discussed controversially. Different studies using corticosteroids to reduce an edema of the optic nerve within its bony canal show similar results in enhancing the vision as do studies that performed a surgical decompression of the nerve. The question of whether a decompression should be performed several days after the trauma is even more difficult.

Material and Methods: We present seven patients (age: 13–58 years) who had a decompression of the optic nerve at the Department of Otolaryngology, Head and Neck Surgery at the University of Würzburg by an endonasal microendoscopic (n = 6) or an extranasal, transfacial approach (n = 1). Additionally, all patients received a high-dose corticosteroid treatment. The etiology was a closed head injury in six cases and an iatrogenic trauma during endonasal sinus surgery in one case. Preoperatively, six of the patients had residual vision and one patient was amaurotic on the affected side. CT scans revealed a fracture of the optic canal in five of the seven cases before surgery. In three cases, the decompression of the optic nerve was performed within 24 hours after the trauma, and in the other cases between 3 and 8 days after the trauma.

Results: In all patients with residual vision, vision increased after surgery. The best result was a visional increase from 0.1 before to 0.8 after surgery. Even in cases of a decompression after 6 to 8 days after the trauma, the vision increased after surgery. Only the patient with amaurosis had no change of vision after surgery.

Conclusion: Decompression of the optic nerve after a skull trauma should be considered in all patients with residual vision, even if the time range after trauma is already several days.