Outcome of optic nerve decompression through neuroendoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy

Objective To investigate the outcome of optic nerve decompression through neuro-endoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy (TON). Methods The consecutive clinical data of 29 patients (32 sides) with TON who were treated at Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University from December 2013 to February 2018 were retrospectively analyzed. Preoperative visual acuity results were as follows: no light perception (NLP) in 15 sides, light perception in 14 sides, and hand moving in 3 sides. All patients underwent optic nerve decompression through neuroendoscopic transethmoidal-sphenoidal approach assisted with intraoperative neuronavigation. High-resolution skull CT scan was performed before the operation. These aspects were documented including the anatomic landmark observed during operation, visual changes of the patients and operative complications. Results The follow-up periods were 5.2±1.1 months (range: 3 to 6 months). Postoperative visual acuity results were as follows: NLP in 10 sides, light perception in 4 sides, hand moving in 4 sides, counting finger in 5 sides, and logMAR≥0.02 in 9 sides. The effective rate of operation was 59.4% (19/32). No surgical complications such as internal carotid artery injury, cerebrospinal fluid rhinorrhea or anosmia occurred. Conclusion Optic nerve decompression through transethmoidal-sphenoidal approach seems to be an effective method for the treatment of TON. The anatomic landmarks of the surgical approach are clearly defined, and intraoperative neuronavigation contributes to the safety of operation and reduces the occurrence of complications. Key words: Optic nerve injuries; Natural orifice endoscopic surgery; Treatment outcome; Optic nerve decompression; Transethmoidal-sphenoidal approach