Endoscopic Endonasal Optic Nerve Decompression for Traumatic Optic Neuropathy: A Systematic Review.

Abstract

Introduction: Traumatic optic neuropathy (TON) is an acute injury to the optic nerve caused by direct or indirect trauma, often resulting in vision loss. Endoscopic transsphenoidal optic nerve decompression (EOND) is a minimally invasive technique designed to relieve pressure on the optic nerve. This systematic review evaluates the efficacy, safety, and visual outcomes of EOND in patients with TON.

Methods: A systematic search of PubMed, Scopus, and Google Scholar was conducted for articles published between 2014 and 2024. Keywords included "optic nerve decompression", "traumatic optic neuropathy", and "endoscopic optic nerve decompression". After screening 42 articles, 16 studies met the inclusion criteria and were analyzed.

Results: All included studies used the endoscopic transsphenoidal approach. The mean visual recovery rate was 58.4%. All patients received postoperative corticosteroids. Study populations ranged from 11.7 to 68.1 years, including 24 females and 354 males. Postoperative complications were reported in 25% of studies, most commonly cerebrospinal fluid (CSF) leaks.

Discussion: Our findings demonstrated that endoscopic endonasal optic nerve decompression (EOND) is a safe and effective option for traumatic optic neuropathy (TON) patients unresponsive to steroids, with a mean visual recovery rate of 58.4% and a low complication profile, most commonly CSF leaks. While EOND offers clear advantages over traditional approaches, including minimal invasiveness and excellent visualization, the heterogeneity of existing data and the limited number of high-quality studies underscore the need for standardized protocols and further prospective research to optimize patient selection and surgical timing.

Conclusion: EOND is a safe and effective intervention for TON patients unresponsive to medical therapy, offering minimal scarring, improved visualization, and rapid recovery. However, the limited number of studies and the heterogeneity of data highlight the need for further high-quality research to optimize outcomes.