Endoscopic Orbital and Optic Nerve Decompression
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.Otolaryngologic Clinics of North America (Impact Factor: 1.49). 11/2006; 39(5):943-58, vi. DOI: 10.1016/j.otc.2006.06.003
The endoscopic transnasal approach is well suited for decompression of both the orbit and optic canal. High-resolution nasal endoscopes provide excellent visualization for bone removal along the orbital apex and skull base. Endoscopic orbital decompression has proved to be safe and effective for the treatment of patients with Graves' orbitopathy; however, the indications and outcomes for endoscopic decompression of the optic nerve remain controversial.
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- "The surgical procedure was modified from what we have previously described. Briefly, patients were prepared in the routine manner for endoscopic sinus surgery under general anesthesia. "
ABSTRACT: Background:Although the endoscopic anterior-to-posterior technique offers many advantages, the long-term effects of the iatrogenic trauma (removal of the uncinate process and anterior ethmoidal sinus) resulting from the complete ethmoidectomy procedure used to gain full access to the optic nerve canal is unknown, and sequelae such as nasal synechia and sinusitis should not be ignored.Aims:The aim of our study is to develop a less invasive procedure for endoscopic optic nerve decompression.Materials and Methods:We proposed a modified trans-sphenoidal surgical procedure for endoscopic optic nerve decompression in five patients with traumatic optic neuropathy (TON), all with high sphenoidal pneumatisation and without Onodi cellulae.Results:After performing a direct sphenoidotomy through the natural ostium of the sphenoid sinus rather than a complete ethmo-sphnoidectomy, we found that the modified approach provided adequate access to the optic nerve canal and the apex using a 45° angled endoscope. Successful decompression of the canal optic nerve was performed trans-sphenoidally in all five TON patients using an angled endoscope. No surgical complications occurred, and none of the patients suffered from anterior ethmoidal sinus or skull base damage.Conclusions:The modified trans-sphenoidal approach is a feasible, safe, effective, and minimally invasive approach for TON patients with high sphenoidal pneumatisation and without supersphenoid-ethmoid cellulae.
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- "Surgical decompression is indicated for long-standing cases recalcitrant to steroid treatment and for acute cases with visual loss. Various external approaches have been adopted to decompress the orbit, of which the Walsh and Ogura approach has been the most favored. This approach provides an effective and cosmetically acceptable result by the removal of the inferior and medial walls of the orbit via the transantral route. "
ABSTRACT: To study the efficacy of endonasal endoscopic orbital decompression in cases of Graves' orbitopathy. A total of 24 orbits in 12 patients underwent endoscopic orbital decompression for graves orbitopathy in the period between October 2002 and December 2010. Indications for surgery included proptosis, corneal exposure, keratitis, and compressive optic neuropathy. Decompression was accomplished by the removal of the medial and part of inferior wall of the orbit and slitting of the orbital periosteum. Pre and postoperative exophthalmometry measurements and visual acuity were recorded and compared. A mean orbital regression of 3.70 mm was noted following endoscopic decompression. The visual acuity improved significantly in one of two eyes decompressed for failing visual acuity secondary to optic nerve compression. Transient diplopia was invariable following surgery but resolved over the next 8 weeks. One case manifested unilateral frontal sinus obstruction symptoms 4 months postoperatively and responded to medical therapy. Endonasal endoscopic orbital decompression provides for an effective, safe, and minimally invasive treatment for proptosis and visual loss of Graves Orbitopathy. Long-term problems with diplopia were not noted in the endonasal endoscopic approach for orbital decompression.
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- "Key words: optic canal; virtual endoscopy; In Space Decompression operation of the optic canal via the nasal path under endoscope has been widely performed in the recent years (Kountakis et al., 2000; Onofrey et al., 2007; Pletcher and Metson, 2007); however, optimizing its effects remains a challenge (Chen et al., 2006; Pletcher et al., 2006). Unsatisfactory results, besides the choosing of an unsuitable indication, were largely associated with otolaryngologists' limited understanding of the real anatomical situation of the optic canal before operation . "
ABSTRACT: Decompression operation of the optic canal via the nasal path under endoscope is widely used, but it is both a challenging and controversial method. Unsatisfactory results were largely associated with otolaryngologists' limited understanding of the real anatomical situations of the optic canal before operation. To provide otolaryngologists with the real situations and data preoperation, multislice helical CT was used to reconstruct the images of the optic canal. Using multislice helical CT-aided three-dimensional reconstructive methods in combination with direct anatomic measurement, we dissected and analyzed the shape of the optic canal and its anatomic relationship with the adjoining structures in 40 intact postmortem skull samples. The In-Space technique clearly showed the structure and the related region of the optic canal. The virtual endoscopy technique showed superbly the spatial appearance and topography of the inner optic canal and also gave the inner structure of the optic canal optically. There was no statistic difference in three-dimensional reconstructive data with that obtained by anatomical measurements and thus can be used to directly instruct the clinic operation. These results demonstrate that a combined In-Space technique with virtual endoscopy can accurately define the subtle structure and the related region of the optical canal. In conclusion, multislice helical CT-based three-dimensional reconstruction is of important value for clinical operations.
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