Optic nerve decompression [Neurosurgery Wiki]

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====== Optic nerve decompression ======

[[Optic canal decompression]].

===== Indications =====
 
[[Indirect optic nerve injury]].

The [[supraorbital approach]] is a [[minimally invasive technique]] and cosmetically favorable alternative to more extended [[approach]]es with longer operative times used for the management of [[optic nerve]] decompression in posttraumatic or compressive [[optic neuropathy]] from skull base pathologies extending into the OC. The relative ease of this approach provides a relatively short learning curve for developing neurosurgeons
((Rigante L, Evins AI, Berra LV, Beer-Furlan A, Stieg PE, Bernardo A. Optic
Nerve Decompression through a Supraorbital Approach. J Neurol Surg B Skull Base. 
2015 Jun;76(3):239-47. doi: 10.1055/s-0034-1543964. Epub 2015 Jan 21. PubMed
PMID: 26225308; PubMed Central PMCID: PMC4433391.)).

see [[Optic pathway glioma]]

===Meningioma===
see [[optic canal meningioma]]


===Idiopathic intracranial hypertension===

Several surgical treatment modalities, including lumboperitoneal or ventriculoperitoneal shunt surgery, [[subtemporal decompression]], endovascular venous sinus stenting, [[optic nerve decompression]] (OND), were used in the management of [[idiopathic intracranial hypertension]] (IIH). Each surgical technique has different advantages and disadvantages. 

====Technique====
Rigante et al. propose a stepwise decompression of the [[optic nerve]] (ON) through a supraorbital minicraniotomy and describe the surgical anatomy of the ON as seen through this approach. 

They also discuss the clinical applications of this approach. 

[[Supraorbital approach]]es were performed on 10 preserved cadaveric heads (20 sides). First, 3.5-cm skin incisions were made along the supraciliary arch from the medial third of the orbit and extended laterally. A 2 × 3-cm bone flap was fashioned and extradural dissections were completed. A 180-degree unroofing of the ON was achieved, and the length and width of the proximal and distal portions of the [[optic canal]] (OC) were measured. Results The supraorbital minicraniotomy allowed for identification of the anterior clinoid process and other surgical landmarks and adequate drilling of the roof of the OC with a comfortable working angle. A 25-degree contralateral head rotation facilitated visualization of the ON. 
((Rigante L, Evins AI, Berra LV, Beer-Furlan A, Stieg PE, Bernardo A. Optic
Nerve Decompression through a Supraorbital Approach. J Neurol Surg B Skull Base. 
2015 Jun;76(3):239-47. doi: 10.1055/s-0034-1543964. Epub 2015 Jan 21. PubMed
PMID: 26225308; PubMed Central PMCID: PMC4433391.)).

===== Endoscopic =====

[[Endoscopic optic nerve decompression]].


====Outcome====
Ophthalmologic factors and factors directly related to the lesion are most important in determining vision outcome. The decision to perform optic nerve decompression for vision loss should be made based on careful examination of the patient and realistic discussion regarding the probability of improvement
((Carlson AP, Stippler M, Myers O. Predictive factors for vision recovery after 
optic nerve decompression for chronic compressive neuropathy: systematic review
and meta-analysis. J Neurol Surg B Skull Base. 2013 Feb;74(1):20-38. doi:
10.1055/s-0032-1329624. Epub 2012 Nov 26. PubMed PMID: 24436885; PubMed Central
PMCID: PMC3699164.
)).
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underwent Navigation guided optic canal decompression via external transcaruncular approach, following which both cases showed visual improvement. Postoperative Visual Evoked Potential and optical coherence technology of Retinal nerve fibre layer showed improvement. These case reports emphasize on the role of stereotactic navigation technology for optic canal decompression in cases of traumatic optic neuropathy
((Bhattacharjee K, Serasiya S, Kapoor D, Bhattacharjee H. Navigation-guided optic canal decompression for traumatic optic neuropathy: Two case reports. Indian J Ophthalmol. 2018 Jun;66(6):879-882. doi: 10.4103/ijo.IJO_1167_17. PMID: 29786012; PMCID: PMC5989526.)).