Thirty Cases of Front-orbital Fibrous Dysplasia: Intraoperative Optic Canal Localization with Three-bits Method and Outcomes Evaluation / 肿瘤防治研究

Objective To investigate the indications of optic canal decompression in the patients with front-orbital fibrous dysplasia and the methods of intraoperative optic canal localization and decompression. Methods We collected 30 cases of fibrous dysplasia. All patients had sufficient images assessment. Patients with symptoms underwent surgery, including front-orbital cranioplasty and optic canal decompression. The frontotemporal epidural approaches were used. If there was a proptosis, the approach was extended with the removal of superior orbital ridge. Six patients undertook intraoperative CT and MRI fusion navigation, assisting in confirming the trunk, orbital and cranial orifice of optic nerve. During the operation, the optic canals were decompressed by three-bits method, to confirm the position of optic nerve. Results There were 30 cases of optic canal decompression and one case of vision loss. The visual acuity and vision field of the remaining patients improved to varying degrees. The proptosis disappeared or alleviated after the operation. Thirteen cases were reconstructed with normal internal plate, five cases with titanium plate, nine cases without reconstruction, and two cases were paved with proliferative broken bone on the orbital top; one case recurred with exophthalmos again after five years, but the visual acuity did not decline. Conclusion For the patients with front-orbital fibrous dysplasia, active surgical treatment should be taken, optic canal decompression should be chosen for diminution of vision, craniofacial anaplasty and orbital decompression should be performed in patients with facial deformity. The epidural approach is a good option to locate the optic nerve from the orbital orifice or cranial orifice. Combined with the three-bits method, we can achieve safe and meticulous optic nerve decompression.

Computer-assisted navigation in orbitofacial surgery

The purpose of this systematic review is to investigate the most common indications, treatment, and outcomes of computer-assisted surgery (CAS) in ophthalmological practice. CAS has evolved over the years from a neurosurgical tool to maxillofacial as well as an instrument to orbitofacial surgeries. A detailed and organized scrutiny in relevant electronic databases, journals, and bibliographies of the cited articles was carried out. Clinical studies with a minimum of two study cases were included. Navigation surgery, posttraumatic orbital reconstruction, computer-assisted orbital surgery, image-guided orbital decompression, and optic canal decompression (OCD) were the areas of interest. The search generated 42 articles describing the use of navigation in facial surgery: 22 on orbital reconstructions, 5 related to lacrimal sac surgery, 4 on orbital decompression, 2 articles each on intraorbital foreign body and intraorbital tumors, 2 on faciomaxillary surgeries, 3 on cranial surgery, and 2 articles on navigation-guided OCD in traumatic optic neuropathy. In general, CAS is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were related to trauma. Treatment of complex orbital fractures was greatly improved by the use of CAS compared with empirically treated control groups. CAS seems to add a favourable potential to the surgical armamentarium. Planning details of the surgical approach in a three-dimensional virtual environment and execution with real-time guidance can help in considerable enhancement of precision. Financial investments and steep learning curve are the main hindrances to its popularity.

Reappraising the neurosurgical significance of the pterion location, morphology, and its relationship to optic canal and sphenoid ridge and neurosurgical implications / 대한해부학회지

Navigation-guided optic canal decompression for traumatic optic neuropathy: Two case reports

Two cases of traumatic optic neuropathy presented with profound loss of vision. Both cases received a course of intravenous corticosteroids elsewhere but did not improve. They 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.

Effect and prognostic factors of endoscopic optic nerve decompression for traumatic optic neuropathy / 中国内镜杂志

Objective To study the curative effect and the prognostic factors of endoscopic traumatic optic neuropathy (TON). Methods The clinical data of 53 patients with TON from 2010 to 2015 years was retrospectively analyzed. Divided the patients into the surgery group and the non-surgery group, according to whether or not accept the treatment of endoscopic optic decompression. And evaluating the potential prognostic factors in chi-square test, group t-test and multiple regression analysis. Results In 53 patients (55 eyes ), 31 eyes have no visual acuity before treated: 8 eyes’ visual acuity was improved in 16 eyes (8/16) that accepted operation; 3 eyes’ visual acuity was improved in 15 eyes (3/15) that with non-operation;24 eyes have visual acuity before treated:11 eyes’ visual acuity was improved in 14 eyes (11/14) that accepted operation;3 eyes’ visual acuity was improved in 10 eyes (3/10) that with non-operation;19 eyes’ visual acuity was improved in 30 eyes (19/30) that accepted operation, the total effective rate was 63.3%, and there was no complications happened in the patients who accepted operation. The age, eye-side, sex, visual acuity, optic canal fracture , orbit fracture , all these factors have no correlation to the prognosis (P>0.05), but the interval time between injury and operation (less than 3 days) and the way of the treatment are benefit to improve vision (P<0.05). Conclusions The endoscopic optic decompression is an effective treatment in TON, and it’s better to improve vision in 3-day after TON.

Analysis of relative factors associated with the improvement in postoperative vision in patients with meningeal tumors of sellar region invaded the optic canal / 中国神经精神疾病杂志

Objective To investigate the clinical factors which improved the postoperative vision in patients with meningeal tumor of sellar region invaded the optic canal. Methods Clinical data was collected from medical records of patient with meningeal tumors invaded optic canal from Jan. 2010 to Oct. 2016.A multiple factor analysis with logistic regression method was used to analyze these data. Results There were 55 cases included in the study. Vision was improved in 26 cases including 15 of 17 cases with early epidual optic canal decompression, 5 of 9 cases with Later optic canal decompression and 6 of 29 cases with curettage of optic canal tumor. A univariate analysis showed that resection grade,tumor adhesion and early epidural optic canal decompression were associated with visual improvement. Regression analysis showed that early epidural optic canal decompression was the only factor which could improve postoperative vision. Conclusion Early epidural optic canal decompression should be a good choice to improve the postoperative vision of meningeal tumors of sellar region invaded the optic canal.

Optic Canal Location Using Computed Tomography (CT)

PURPOSE: In this study we evaluated the location and shape of the optic canal using computed tomography (CT) for diagnosis and treatment of posterior orbital diseases. METHODS: Fifty patients, who had received a facial bone CT between November 2012 and June 2013 at Korea University Hospital were included in the present study. The location and shape of the optic canal was evaluated using 9 parameters on CT (P1: nasal bone tip; P2: middle point of tuberculum sellae; P3: root of columella nasi; P4: orbit end of the optic canal; P5: cranium end or the optic canal; P6: P1's projection on L2; L1: line that links P1 and P2; L2: goes through P3 and parallel to L1; L3: bisector of right and left and goes through P1). RESULTS: The distance between P3 and P4 was 81.5 mm and 75.6 mm in males and females, respectively (p = 0.001). The distance between P3 and P5 was 88.5 mm and 82.1 mm in, males and females, respectively (p = 0.001). The width of the orbital end and cranium end of the optic canal, the length of the optic canal was 2.4 mm, 4.1 mm, 10.9 mm in males and 2.3 mm, 3.6 mm, 10.2 mm, in females, respectively. CONCLUSIONS: By determining the location and shape of the optic canal, these results can facilitate endoscopic approaches to diagnose and manage posterior orbital diseases as well as manage and prevent disorders associated with the optic canal.

Tuberculum sellae meningiomas: surgical considerations / Meningiomas do tuberculo selar: aspectos cirúrgicos

We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome.

Apresentamos nossa experiência em 23 pacientes operados com meningiomas do tubérculo da sela, com enfoque na descompressão do nervo óptico e nos sintomas visuais do pós-operatório. Vinte e três pacientes com meningiomas do tubérculo da sela foram operados entre janeiro de 1997 e dezembro de 2008, através do acesso subfrontal via ostetomia supraorbital. Remoção do teto do canal óptico por via extra ou intradural foi realizada em 17 pacientes. Sintomas visuais no pré-operatório ocorreram em 21 pacientes, 2 eram assintomáticos. Melhora visual ocorreu em 10, permaneceu inalterada em 5 e piorou em 2 pacientes. No pós-operatório o campo visual normalizou-se em 17 pacientes, permaneceu inalterado em 4 e diminuiu em 2. Descompressão dos nervos ópticos foi realizada em 17 pacientes. Ressecção total dos meningiomas do tubérculo da sela foi possível em 19 pacientes. Abertura do canal óptico permitiu a manipulação do nervo óptico sem novos déficites.

Recent progress in radiological study of cranial nerve injury / 第二军医大学学报

The vast majority of traumatic cranial nerve injuries are associated with compression of fragment fracture, and microsurgery outside the epidural can be used for most of the cases. Therefore, early and accurate diagnosis of cranial nerve injury is especially important. As the cranial nerves go out of the cranial cavity through the holes and cracks of the skull base, and there are a number of special structures through which cranial nerve goes into the human skull, and they include the optic canal, superior orbital fissure, facial nerve canal, jugular foramen and so on. Most traumatic cranial nerve injuries are associated with these structures; however, the common imaging examination is very difficult for these structures due to their deep location. To further study the imaging diagnosis of cranial nerve injury associated with traumatic brain injury, this paper reviews the radiological technology for examination of the special positions in the skull.

Diagnosis and treatment of optic nerve injury in double wall optic canal / 国际外科学杂志

Objective To approch the characteristic of diagnosis and treatment of optic nerve injury in double wall optic canal.Methods Six patients,with double wall optic canal found by CT,were treated by drug,operation and visual rehabilitation training.The results of CT,vision-evoked potential and visual recovery were analysed.Results In 6 patients,4 were holo-double wall optic canal and 2 were mero-double wall optic canal,4 were found having bone fracture.All the 6 cases were effective to treatment including 3 patients whose vision was over 0.1.Conclusion In double wall optic canal,the degree of optic nerve injury is slight,visual recovery is better by drug,operation and visual rehabilitation training.

High resolution CT study on post-traumatic visual loss / 眼科

Objective To analyze the high resolution CT(HRCT)appearance and its clinical significance in patients with post-traumatic visual loss.Design Retrospective study.Participants 150 patients with post-traumatic visual loss.Methods The optic canal HRCT of 150 patients admitted from March to June of 2007 by Department of Emergency for post-traumatic visual loss were ana- lyzed retrospectively.Main Outcome Measures Pedilection sites and their incidence rates of optic canal and orbital apex region. Results Optic canal fractures were found in 78 patients,manifesting as rupture and displacement of optic canal wall,accompanied with or without adjacent structure fractures.(1)Among 88 sides of fractures,22 sides presented with single fracture,and 66 sides with multi- ple fractures,revolving several optic canal walls.(2)156 sites of fractures were displayed in 78 patients,and the most frequent types were displacement fractures(47.4%).(3)Accompanied adjacent structure fractures were found in 73 cases of the 78 patients,while 40 cases were found in 72 patients without optic canal fracture.Totally,283 sites of adjacent structure fractures were discovered with the most frequent sites of orbital apex region,accounting for 44.5%.Conclusion HRCT could well display optic canal fractures and accom- panied fractures of adjacent structures,providing important informations for diagnosis and intervention of traumatic visual loss.(Oph- thalmol CHN,2007,16:326-329)

The significance of transnasal endoscopic optic canal decompression in traumatic optic neuropathy / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the significance of transnasal endoscopic optic decompression in traumatic optic neuropathy. METHODS Four patients with blindness from traumatic optic neuropathy were treated with transnasal endoscopic optic decompression. RESULTS Two patients improved in visual acuity to CF/50 cm and light perception. Two patients didn’t improve after surgery. CONCLUSION Transnasal endoscopic optic decompression is significant in the management of traumatic optic neuropathy due its effectiveness and minimal invasiveness. It’s implications can be enlarged under some circumstances.

Important topics in diagnosis of neuro-ophthalmologic diseases / 眼科

Neuro-ophthalmology is a subspecialty of both neurology and ophthalmology concerning visual problems that are related to the nervous system. As the rapid development of computer technology, information technology and radiology, the development of neuro-ophthalmology is in the best period in history. The following important topics are worthy of attention: 1) the diagnosis and therapy of carotid artery stenosis related ophthalmopathy;2)the relationship between papilledema and cranial venous sinus thrombosis; 3) the diagnosis of optic canal fracture with high resolution computer tomography;4)the relationship between optic neuritis and multiple sclerosis.

Pneumatization of the sphenoid sinus and its surrounding neurovascular structures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sphenoid sinus faces the cavernous sinuses in which neurovascular structures such as the cavernous segment of the internal carotid arteries (ICA), optic nerve, and trigerminal nerve are located. In addition, it separates the pituitary gland from the nasal cavity. Therefore, surgeons are required to understand its detailed anatomy for transsphenoidal approach (TSA) or optic nerve decompression. This study is aimed to investigate the surgical anatomy of the sphenoid sinus and its clinical application using Korean adult cadaveric heads. MATERIAL AND METHODS: One hundred sagittally-divided adult cadaveric heads were used. After removing the sinus mucosa meticulously, careful examination and photodocumentation were done serially. The analysed items were the pneumatization type of the sphenoid sinus, the relationship between the pneumatization type of the sphenoid sinus and the incidence of bulging of the optic canal, segment 1 and 3 of ICA, maxillary nerve, and pterygoid nerve, and the incidence of bony dehiscence and thickness of bone at the bulging site of various neurovascular structures. RESULT: The sellar type was found in 90% of the subjects. The incidence of bulging of neurovascular structures were from 34% to 65%, and the incidence of bony dehiscence at the bulging site were from 0% to 9.6%. The more pnermatized the sphenoid bone was, the higher the prevalence of bulging became. The average thickness of bone was less than 0.5 mm. In the complete sellar type, the distances from the anterior wall of the sphenoid sinus to the bulging site at the optic canal, and to segment 1 and 3 of ICA were about 1.9 mm, 19.3 mm, and 9.5 mm, respectively. The distances from the superior wall of the sphenoid sinus to the bulging site at the optic canal and to the maxillary nerve were about 3.7 mm and 17.3 mm, respectively. Bulging of the optic canal attached to the anterior and the superior walls of the sphenoid sinus was 45% and 34%, respectively. CONCLUSION: By elucidating the relationship between the sphenoid sinus and surrounding vital neurovascular structures, this study might be able to provide essential anatomical knowledge for surgeons to reduce surgical complication in applying to the sphenoid sinus.

Effect of High dose Corticosteroid and Optic Canal Decompression on Traumatic Optic Nerve Injury

PURPOSE: To evaluate the effect of high dose corticosteroid and optic canal decompression on the traumatic optic nerve injury. METHODS: Twenty six patients who were diagnosed to have traumatic optic nerve injury, were divided into two groups in which one group received corticosteroid therapy while the other group underwent optic canal decompression combined with corticosteroid therapy. RESULTS: Visual acuity increased by > OR =3 lines of LogMAR scale in 47% of the corticosteroid group, in 28% of operation and steroid group, and in 42% of overall cases. But the degree of visual acuity improvement had no difference between two groups(p=0.72). As the patients were divided into two groups based on initial visual acuity such as no light perception and light perception or better, the initial visual acuity did not have influence on the final visual outcome in both corticosteroid group and operation and steroid group(p=0.78, p=0.33). CONCLUSIONS: This result suggest that effect of high dose corticosteroid and optic canal decompression on traumatic optic nerve injury is not different.

High Dose Steroid and Optic Canal Decompression in the Treatment of Traumatic Optic Neuropathy

We compared the result of 6 patients[group A]treated with high dose steroid only with the result of 14 patients[group B]treated with optic canal decompression after at least 24 hours of high dose steroid therapy without improvement. 4 of 6 patients[66%]in group A and 7 of 14 patients[50%]in group B improved in visual acuity.But 1 of 6 patients[17%] in group A and 6 of 14 patients[43%]in group B had marked improvement in visual function[above 0.02].Of 5 patients with optic canal fracture in orbit CT in group B, all had improved visual function and 4 had marked improvement in visual function. If CT demonstrates bony fragments impinging on intracanalicular optic nerve, or if vision deteriorates or fails to improve during the first 24 hours of high dose steroid and initial visual acuity is no light perception, optic canal decompression is considered effective and valid treatment modality in TON.

A Case of Mucocele in Optic Canal

Intraorbital or intracranial mucoceles usually arise from paranasal sinus and enlaarge sufficiently to compress orbital or intracranial structures: primary intraorbitocranial mucocele developing from optic canal or anterior clinoid process is extrmely rare. We experienced a case of 48-year-old female patient presenting headache and diplopia with 5 days` duration, whose primary mucocele had arisen from anterior clinoid process near the optic canal unassociated with paranasal sinus. We report the case herein with a review of the literature.

Irreversible Visual Loss due to Chronic Sinusitis in a Patient with Optic Canal Dehiscence / 대한이비인후과학회지

A 56-year-old female with complete unilateral visual loss due to chronic sinusitis is presented. The progress of visual loss was gradual, symptomless and was distinguished from the orbital complication of the acute sinusitis. She had previous history of ipsilateral Caldwell-Luc and ethmoidectomy operation. Computed tomography showed a bony dehiscence of optic canal at posterior ethmoid which was filled with soft tissue density. Middle meatal adhesion and sinusitis caused by the previous operation was eliminated and subsequently, optic nerve decompression was complete. However, the visual loss was irreversible and could not be restored. This case suggests that the bony dehiscence of optic canal is important factor that causes visual loss in the existence of sinusitis.

Endoscopic Optic Canal Decompression

The visual loss owing to acute optic nerve injury after blunt head trauma has been reported about 5% at the incidence. But it has been real circumstances that we still don`t have the exact knowlege about surgical indication, operation time and steroid dosage for this candidate. Lately, endoscopic surgery was introduced for treatment of orbital disease instead of classic external approach and we have performed and report endoscoic endonasal optic canal decompression followed by megadose steroid injection in 5 patients who experienced visual loss due to optic canal fracture following trauma.

Clinical Evaluation of the Traumatic Optic Neuropathy

The nineteen patients(20 eyes) of traumatic optic neuropathy were investigated to evaluate the effectiveness of high dose corticosteroid for the visual improvernent in the early treatment of this disease. The relationships between the affected region and visual improvement, the interval to treatment and final visual acuity, the initial visual acuity and final visual acuity were studied. 250mg of methylprednisolone was administered intravenously every 6 hours followed by tapering using oral prednisone. The optic canal decompression was performed in five patients suspected swelling of optic nerve or optic canal fracture revealed by orbital CT. It is difficult to know the relationships between the affected region and visual improvement, the interval to treatment and final visual acuity. The vision was improved in nine of eleven patients who had an initial visual acuity of above light perception, but in the two of nine patients who had an initial visual acuity of no light perception. The two of five patients treated with a combina tion of high dose corticosteroid and optic canal decompression showed improved visual function. In initial treatment of traumatic optic neuropathy, high dose corticosteroid was effective and combined optic canal decompression was helpful, if indicated.