Surgical Freedom Evaluation During Optic Nerve Decompression. Laboratory Investigation.

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Surgical Freedom Evaluation During Optic Nerve Decompression. Laboratory Investigation.

World Neurosurg. 2017 Feb 20;:

Authors: Di Somma A, Andaluz N, Gogela S, Cavallo LM, Keller JT, Prats-Galino A, Cappabianca P

Abstract
BACKGROUND AND AIMS: Various surgical routes have been used to decompress the intracanalicular optic nerve. Historically, a transcranial corridor was used, but more recently ventral approaches (endonasal and/or transorbital) have been proposed, individually or in combination. The present study aims to detail and quantify the amount of bony optic canal removal one may achieve via transcranial, transorbital and endonasal pathways. Additionally, the surgical freedom of each approach was analyzed.
METHODS: In 10 cadaveric specimens (20 canals), optic canals were decompressed via pterional, endoscopic endonasal, and endoscopic superior eyelid transorbital corridors. The surgical freedom and circumferential optic canal decompression afforded by each approach was quantitatively analyzed. Statistical comparison was carried using a non-paired Student t-test.
RESULTS: An open pterional transcranial approach allowed the greatest area of surgical freedom (transcranial: 10.9 ± 3.4 cm2; transorbital 3.7 ± 0.5 cm2; endonasal homolateral 1.1 ± 0.6 cm2 and endonasal contralateral 1.1 ± 0.5 cm2) with widest optic canal decompression when compared with the other two ventral routes (transcranial: 245.2°; transorbital: 177.9°; endonasal: 144.6°). These differences reached statistical significance for the transcranial approach.
CONCLUSIONS: This anatomical contribution provides a comprehensive evaluation of surgical access to the optic canal via three distinct, but complementary, approaches: transcranial, transorbital and endonasal. Our results show that, as expected, a transcranial approach achieved the widest degree of circumferential optic canal decompression and the greatest surgical freedom for manipulation of surgical instruments. Further surgical experience is necessary to determine the proper surgical indication for the transorbital approach to this pathology.

PMID: 28232210 [PubMed - as supplied by publisher]

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