Transnasal Edoscopic Sphenoethmoidal Optic Nerve Decompression On 37 Eyes With Traumatic Optic Neuropathy

OBJECTIVES: The proper management of traumatic injures to the optic nerve is controversial. Recommendations for management of traumatic injuries to the optic nerve in the literature include expectant management, medical therapy, surgical treatment, and medical therapy combined with surgical decompression. Traditional surgical approaches to optic nerve decompression (OND) are a craniotomy approach, extranasal transethmoidal approach, transorbital approach, transantral approach, and intranasal microscopic approach. Recent advances in instrumentation and surgical techniques have made an endoscopic approach to OND possible. The goal of this study is to search for a better surgical method for treatment of traumatic optic neuropathy and to identify factors affecting improvement in patients treated with OND and the diagnostic value of VEP in the traumatic optic neuropathy . METHODS: Thirty-seven patients(37 eyes)with traumatic optic neuropathy were enrolled. Transnasal endoscopic sphenoethmoidal optic nerve decompression was performed within 30 days after injury. Each patient was alert and free of injury to the globe when evaluated before surgery. All the patients were given preoperative and postoperative steroids. 13 patients were checked by VEP examination before and after surgery. The analyses of variations of visual acuity in final stage and VEP were to be done to determine the factors affecting the outcome of visual acuity and the diagnostic value of VEP in the traumatic optic neuropathy .RESULT: The final visual acuity was improved in 21 patients (56. 76 %) . The final visual acuity improved in 13/28 patients with no perception of light and 8/9 patients with light perception or better. The effectiveness in patients with light perception or better was significantly higher than those with no light perception, (p=0.029). Improvements were no significantdifference between patients whose course after injury less than 7 days and those whose course after injury were 7 days and more. (P=0. 104). The patients with presence of P-100 wave in VEP had better improvements than those without it(P=0. 005).CONCLUSION: The endoscopic method offers many advantages over the traditional approaches. Decreased morbidity, preservation of olfaction, rapid recovery time, more acceptable cosmetic results with no external scars, no risk of injury to the developing teeth in children, and less operative stress in a patient who may have multisystem trauma are only some of the benefits associated with the endoscopic OND. The key factor in determining nerve recovery was associated with the severity of optic nerve trauma. No light perception at initial is an important risk factor in the outcome. There is no reason to give up treatment even if the time after injury is more than 7 days. With or without P-100 wave in VEP is an important factor associated with prognosis.