Optic nerve decompression
by Vicky S Khattar, Vicky Bachi T

Jaypee’s Video Atlas of Operative Otorhinolaryngology AND Head & Neck Surgery

by Vicky S Khattar, Bachi T Hathiram
About Video

This compilation of videos demonstrates endoscopic optic nerve decompression for a variety of indications. (i) Traumatic Optic Neuropathy with displaced fracture of the left optic canal: Described in this video is the most common indication for optic nerve decompression, i.e. traumatic optic neuropathy. Here the intracanalicular segment of the optic nerve has been decompressed. (ii) Co-existent post-traumatic optic canal fracture and CSF leak: Occasionally trauma will result in multiple concomitant injuries such as optic neuropathy along with cerebrospinal fluid (CSF) leak. The situation becomes tricky as CSF leaks usually require a multiple-layered closure, while after optic nerve decompression, one should avoid any pressure on the nerve, leave alone nasal packing. To overcome this situation, one may use a fat bath-plug to seal the CSF leak, after performing an optic nerve decompression. (iii) Blindness caused by an angiofibroma compressing the right optic nerve, relieved after emergent tumor removal: Angiofibromas growing into the sphenoid sinus can cause pressure on the lateral nasal wall and result in blindness. If detected and treated in time, this blindness may be partially, and on occasions, even completely, reversed following gentle tumor removal. (iv) Granulomatous mass removed piecemeal over an exposed optic nerve and dura: This video demonstrates the removal of a mass compressing the optic nerve. (v) Allergic fungal rhinosinusitis causing optic nerve compression: Long-standing allergic fungal rhinosinusitis may cause visual compromise by a gradual compression of the optic nerve. Even though the disease does not penetrate the dural nerve sheath, it can cause a progressive degeneration of the nerve. Endoscopic evacuation of the fungal debris may be done, but the visual recovery may not be optimal due to the long-standing nerve compression.

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