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Endoscopic endonasal decompression of the optic nerve in the setting of compressive lesions: how I do it

  • How I Do it
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Abstract

Background

Many lesions in the anterior skull base may compress the optic nerve (ON), leading to vision loss, and even irreversible blindness. Although decompression of the optic nerve has traditionally been achieved transcranially, the endoscopic endonasal approach (EEA) is gaining traction as a minimally invasive approach recently.

Method

We describe the key steps of an EEA ON decompression. The relevant surgical anatomy with illustration is described. Additionally, a video detailing our technique and instruments on an illustrative case is provided.

Conclusion

Endoscopic endonasal approach ON decompression with a straight feather blade is a feasible, minimally invasive procedure to decompress the ON in the setting of anterior skull base mass lesions.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Agosti E, Leonel LCPC, Alexander AY, Graepel S, Pinheiro-Neto CD, Peris-Celda M (2022) Endoscopic endonasal surgical anatomy of the optic canal: key anatomical relationships between the optic nerve and ophthalmic artery. Acta Neurochir (Wien). https://doi.org/10.1007/s00701-022-05395-4

  2. Bander ED, Singh H, Ogilvie CB et al (2018) Endoscopic endonasal versus transcranial approach to tuberculum sellae and planum sphenoidale meningiomas in a similar cohort of patients. J Neurosurg 128(1):40–48. https://doi.org/10.3171/2016.9.JNS16823

    Article  PubMed  Google Scholar 

  3. Cabrilo I, Dorward NL (2020) Endoscopic endonasal intracanalicular optic nerve decompression: how I do it. Acta Neurochir (Wien) 162(9):2129–2134. https://doi.org/10.1007/s00701-020-04476-6

    Article  PubMed  Google Scholar 

  4. Caporlingua A, Prior A, Cavagnaro MJ et al (2019) The intracranial and intracanalicular optic nerve as seen through different surgical windows: endoscopic versus transcranial. World Neurosurg 124:522–538. https://doi.org/10.1016/j.wneu.2019.01.122

    Article  PubMed  Google Scholar 

  5. Chen B, Zhang H, Zhai Q, Li H, Wang C, Wang Y (2022) Traumatic optic neuropathy: a review of current studies. Neurosurg Rev 45(3):1895–1913. https://doi.org/10.1007/s10143-021-01717-9

    Article  PubMed  Google Scholar 

  6. Jacquesson T, Abouaf L, Berhouma M, Jouanneau E (2014) How I do it: the endoscopic endonasal optic nerve and orbital apex decompression. Acta Neurochir (Wien) 156(10):1891–1896. https://doi.org/10.1007/s00701-014-2199-1

    Article  PubMed  Google Scholar 

  7. Labib MA, Prevedello DM, Fernandez-Miranda JC et al (2013) The medial opticocarotid recess: an anatomic study of an endoscopic key landmark for the ventral cranial base. Neurosurgery 72. https://doi.org/10.1227/NEU.0b013e318271f614

  8. Luxenberger W, Stammberger H, Jebeles JA, Walch C (1998) Endoscopic optic nerve decompression: the Graz experience. Laryngoscope 108(6):873–882. https://doi.org/10.1097/00005537-199806000-00016

    Article  CAS  PubMed  Google Scholar 

  9. Pletcher SD, Metson R (2007) Endoscopic optic nerve decompression for nontraumatic optic neuropathy. Vol 133. https://jamanetwork.com/. Accessed 2/4/23

  10. Sakata K, Takeshige N, Nagata Y et al (2019) Endoscopic endonasal removal of primary/recurrent meningiomas in the medial optic canal: surgical technique and long-term visual outcome. Oper Neurosurg 17(5):470–480. https://doi.org/10.1093/ons/opz001

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Ohio State University College of Medicine, Columbus, OH, USA

    Alexander Keister

  2. Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA

    Alexander Keister, Kyle C. Wu, Guilherme Finger & Daniel Prevedello

Authors
  1. Alexander Keister
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  2. Kyle C. Wu
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  3. Guilherme Finger
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  4. Daniel Prevedello
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Contributions

Conception and design: DP, KW; supervision: DP, KW; materials: DP, KW; data collection and/or processing: AK; analysis and/or interpretation: AK; literature review: AK, GF; writer: AK, DP; critical review: GF, KW.

Corresponding author

Correspondence to Alexander Keister.

Ethics declarations

Ethics approval

Pursuant to our institutional review board’s bylaws, as this manuscript includes less than three participants, no human subject review nor approval is required. Notwithstanding, this study followed all recommendations set forth in the Belmont Report.

Consent to participate

All patients in the study consented to the procedure.

Consent for publication

All patients in the study consented to their de-identified data being published.

Conflict of interest

The authors declare no competing interests.

Additional information

Key points

• Various pathologies in the anterior skull base, such as anterior clinoid, transsellar, and olfactory groove meningiomas, may lead to irreversible blindness by compromising the optic nerve.

• While transcranial decompression has been the traditional method, the endoscopic endonasal approach (EEA) is gaining popularity as a minimally invasive alternative, showing better visual outcomes.

• Understanding the relevant surgical anatomy is crucial, including the sphenoid sinus structures, clinoid portion of the internal carotid artery, and the medial opticocarotid recess (MOCR), which is a key endoscopic ventral landmark.

• The MOCR marks the ophthalmic portion of the internal carotid artery, and its relationship with the optic nerve in the optic canal is significant for the EEA, especially concerning the lateral branch.

• Patients are positioned supine with their heads secured in a Mayfield frame, and stereotactic neuronavigation is calibrated following induction and intubation.

• The transsphenoidal phase involves standard transnasal dissection, middle turbinectomy, nasoseptal flap creation, ethmoidectomies, sphenoid osteotomy, and careful drilling down of the sphenoid sinus to expose relevant structures.

• The optic nerve decompression involves opening the optic sheath using specialized tools, including a back cutting feather blade, dissecting the dura, and stripping and decompressing the optic nerve. This process allows exposure of the optic canal for 270–360° disease resection in most cases.

• DuraGen® graft is used for reconstructing the dural defect, and the nasoseptal flap is rotated upwardly to cover the craniotomy. Gelfoam® pieces sustain the flap in position, followed by a Valsava maneuver to check for residual leaks.

• Difficult sinusoidal anatomy, prior septoplasty, and other factors may limit the EEA. To avoid complications, careful preoperative imaging studies, routine use of neuronavigation, and specific precautions during bone drilling are recommended.

• Patients should be informed about potential risks, and follow-up with a neuro-ophthalmologist is essential for monitoring visual changes.

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Keister, A., Wu, K.C., Finger, G. et al. Endoscopic endonasal decompression of the optic nerve in the setting of compressive lesions: how I do it. Acta Neurochir 166, 129 (2024). https://doi.org/10.1007/s00701-024-05994-3

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