Authors of section

Authors

Scott Bartlett, Michael Ehrenfeld, Gerson Mast, Adrian Sugar

Executive Editor

Edward Ellis III

General Editor

Daniel Buchbinder

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Optic nerve decompression with limited resection

1. Introduction

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.

2. Approach

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

optic nerve decompression with limited resection

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

optic nerve decompression with limited resection

3. Technique

Craniotomy

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

optic nerve decompression with limited resection

Exposure to the deep orbit

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.

optic nerve decompression with limited resection

Optic nerve decompression

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.

Closure

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

fibrous dysplasia involving optic nerve

4. Case example

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

optic nerve decompression with limited resection

Planar imaging of the same patient.

optic nerve decompression with limited resection

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.

optic nerve decompression with limited resection

5. Aftercare

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