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ORIGINAL ARTICLE
Year : 2014  |  Volume : 6  |  Issue : 6  |  Page : 270-273

A modified surgical procedure for endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy


1 Allergy and Cancer Center, Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
2 Department of Otolaryngology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China

Correspondence Address:
Huabin Li
Allergy and Cancer Center, Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, 510 080, Guangzhou
China
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Source of Support: This study was supported by National Natural Science Grant of China (No. 81271054) and a grant from the Ministry of Hygiene (No. 201202005) and Program for New Century Excellent Talents in University (No. NCET-10-0851)., Conflict of Interest: None


DOI: 10.4103/1947-2714.134372

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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 o 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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