Carotid-falciform optic neuropathy: microsurgical treatment.

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Carotid-falciform optic neuropathy: microsurgical treatment.

World Neurosurg. 2017 May 16;:

Authors: Woodall MN, Alleyne CH

Abstract
BACKGROUND: Several recent reports have implicated vascular ectasia and vessel contact with dysfunction of the visual apparatus. A subset of patients with pre-chiasmatic visual deterioration have an ectatic internal carotid artery (ICA) that displaces and flattens the optic nerve (ON) rostrally as the ON exits the skull base. We will offer a proposed pathophysiological mechanism and describe a straightforward surgical technique for dealing with this interesting problem.
METHODS: Via an ipsilateral pterional craniotomy, the bony roof of the optic canal is removed. The falciform ligament is opened in parallel to the ON. Adhesions between the ICA and ON are then dissected, and a Teflon pledget is placed between the ICA and ON to complete the decompression.
RESULTS: Patients both in the literature and in this series experienced an improvement in their vision post-operatively.
CONCLUSION: We propose that three mechanisms contribute to this carotico-faliciform optic neuropathy: 1) mass effect from ICA ectasia, 2) ON irritation from vessel pulsatility, and 3) indirect compression by the falciform ligament from above. This fascinating disease process can be treated safely using standard microsurgical techniques with excellent outcomes.

PMID: 28526645 [PubMed - as supplied by publisher]

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