Endoscopic Transnasal Treatment of Traumatic Optic Neuropathy: Our Experience

Introduction: At present, the treatment of traumatic optic neuropathy (TON) remains a vexed question. In addition to medical treatment based on systemic steroids, the surgical decompression of the intracanalicular portion of the optic nerve can be done through a minimally invasive approach. Patients and Method: Fifteen patients affected by TON were studied through a retrospective analysis. They came to our department from 2002 to 2008. In 1 case, the TON was bilateral, and in 2 cases there was a concomitant anterior skull base post-traumatic CSF leak. The most frequent etiologies were car accidents (72%) and iatrogenic damage due to previous functional endoscopic surgery (13%). All patients underwent preoperative ophthalmologic evaluation and CT scan. Systemic steroids were administered in all patients before surgery, which was performed within 12 hours (38%), 48 hours (36%), and later than 48 hours from the traumatic event. All patients underwent endonasal endoscopic decompression of the optic nerve, and 2 cases also had associated anterior skull base duraplasty. Results: Fifty-six percent of patients reported visual improvement after treatment. There were no complications in the intraoperative period and in the postoperative period, with a mean follow-up of 41 months. Conclusion: The endonasal endoscopic decompression of optic nerve is an advantageous therapeutic option in case of TON. Its association with medical treatment offers the best solution in terms of risk and benefit for the patient.