Effectiveness of endoscopic optic nerve decompression surgery for traumatic optic neuropathy with optic nerve canal fracture

Yuichi Ikari, Hiroyuki Ozawa, Keisuke Yoshihama, Shin Saito, Nana Nakahara, Fumihiro Ito, Yoshihiko Hiraga, Yoshihiro Watanabe, Mariko Sekimizu, Yoichiro Sato, Toshiki Tomita, Yu Ohta, Dai Kamamoto, Masahiro Toda, Kaoru Ogawa

Research output: Contribution to journalArticle

Abstract

Traumatic optic neuropathy often occurs as a complication of head and mid facial injury, and can cause permanent impairment of the visual acuity. From previous studies, optic nerve decompression surgery has been recommended for cases of traumatic optic neuropathy with optic nerve canal fracture. However, the indications for this surgery still remain controversial. Moreover, optic nerve canal fracture cannot be detected even by computed tomography (CT) in some cases. Patients diagnosed as having traumatic optic neuropathy with optic nerve canal fracture are treated by endoscopic optic nerve decompression surgery and steroid administration, by otorhinolaryngologist in collaboration with neurosurgeons and ophthalmologists at Keio University Hospital. Six patients were treated between May 2015 and May 2017. They ranged in age from 17 to 78 years old, and the intervals from injury to surgery ranged from 19 hours to 6 days. Five patients had injury of the outer half of the eyebrows. Preoperative CT revealed optic canal fracture in only 3 cases, whereas intraoperatively, all 6 cases were detected to have fracture. Preoperative visual acuity was hand motion or better in 4 patients, and no light perception in 2 patients. The visual acuity improved postoperatively in 5 patients. No improvement was observed in the patient who underwent surgery 6 days after the injury. Blunt injury on the outer half of the eyebrow was a useful clue for the diagnosis of optic nerve canal fracture, especially in cases where it could not be detected by CT. In cases of traumatic optic neuropathy with optic nerve canal fracture, early decompression of the optic canal and steroid administration play a key role in the recovery of the visual acuity.

Original languageEnglish
Pages (from-to)1373-1380
Number of pages8
JournalJournal of Otolaryngology of Japan
Volume121
Issue number11
DOIs
Publication statusPublished - 2018 Jan 1

Fingerprint

Optic Nerve Injuries
Optic Nerve
Decompression
Visual Acuity
Eyebrows
Tomography
Wounds and Injuries
Steroids
Facial Injuries
Nonpenetrating Wounds
Ambulatory Surgical Procedures
Hand
Head
Light

Keywords

  • Early surgery
  • Endoscopic optic nerve decompression surgery
  • Optic nerve canal fracture
  • Traumatic optic neuropathy

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Effectiveness of endoscopic optic nerve decompression surgery for traumatic optic neuropathy with optic nerve canal fracture. / Ikari, Yuichi; Ozawa, Hiroyuki; Yoshihama, Keisuke; Saito, Shin; Nakahara, Nana; Ito, Fumihiro; Hiraga, Yoshihiko; Watanabe, Yoshihiro; Sekimizu, Mariko; Sato, Yoichiro; Tomita, Toshiki; Ohta, Yu; Kamamoto, Dai; Toda, Masahiro; Ogawa, Kaoru.

In: Journal of Otolaryngology of Japan, Vol. 121, No. 11, 01.01.2018, p. 1373-1380.

Research output: Contribution to journalArticle

Ikari, Yuichi ; Ozawa, Hiroyuki ; Yoshihama, Keisuke ; Saito, Shin ; Nakahara, Nana ; Ito, Fumihiro ; Hiraga, Yoshihiko ; Watanabe, Yoshihiro ; Sekimizu, Mariko ; Sato, Yoichiro ; Tomita, Toshiki ; Ohta, Yu ; Kamamoto, Dai ; Toda, Masahiro ; Ogawa, Kaoru. / Effectiveness of endoscopic optic nerve decompression surgery for traumatic optic neuropathy with optic nerve canal fracture. In: Journal of Otolaryngology of Japan. 2018 ; Vol. 121, No. 11. pp. 1373-1380.
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