Optic nerve decompression with limited resection

In cases in which the optic canal is involved, progressive loss of vision may occur. These patients need to be monitored closely by a neuro-ophthalmologist for signs of early visual change.

If this occurs, optic nerve decompression is recommended to preserve vision.

Prophylactic decompression in the absence of visual changes is not recommended.

A transcranial approach to the anterior cranium base and superior orbit is used.

Exposure is made through a coronal incision and deep dissection into the superior orbit.

A craniotomy on the affected side is performed by the neurosurgeon with clearing of the anterior and middle fossae.

Exposure to the deep orbit is facilitated by removal of a frontal bandeau.

This involves a temporal tenon, a cut of the lateral orbital wall, a nasal frontal osteotomy and a trans-cranial orbital roof osteotomy.

Once the bandeau is freed, it is removed and set aside while the neurosurgeon performs a direct optic nerve decompression from above. This is facilitated by intraoperative CT guided navigation.

Following decompression, the frontal bandeau and craniotomy are replaced anatomically and the coronal incision is closed in a standard fashion.

3D imaging of 7 year old female with optic nerve compression on the left and progressive fibrous dysplasia of the optic canal.

Planar imaging of the same patient.

Optic nerve decompression was performed as described previously.

In addition, contour of excessive fibrous dysplasia of the frontal bone was completed. Post-op 3D CT shows widely decompressed optic canal and more normal frontal bone shape.

Aftercare involves neuro and visual monitoring, wound drainage and standard postcraniotomy care.