title: A modified surgical procedure for endoscopic optic nerve decompression for the treatment of traumatic optic neuropathy.
abstract: BACKGROUND
  Although the endoscopic anterior-to-posterior technique offers many advantages, the long-term effects of the iatrogenic trauma (removal of the uncinate process and anterior ethmoidal sinus) resulting from the complete ethmoidectomy procedure used to gain full access to the optic nerve canal is unknown, and sequelae such as nasal synechia and sinusitis should not be ignored.
  
  
  OBJECTIVE
  The aim of our study is to develop a less invasive procedure for endoscopic optic nerve decompression.
  
  
  METHODS
  We proposed a modified trans-sphenoidal surgical procedure for endoscopic optic nerve decompression in five patients with traumatic optic neuropathy (TON), all with high sphenoidal pneumatisation and without Onodi cellulae.
  
  
  RESULTS
  After performing a direct sphenoidotomy through the natural ostium of the sphenoid sinus rather than a complete ethmo-sphnoidectomy, we found that the modified approach provided adequate access to the optic nerve canal and the apex using a 45° angled endoscope. Successful decompression of the canal optic nerve was performed trans-sphenoidally in all five TON patients using an angled endoscope. No surgical complications occurred, and none of the patients suffered from anterior ethmoidal sinus or skull base damage.
  
  
  CONCLUSIONS
  The modified trans-sphenoidal approach is a feasible, safe, effective, and minimally invasive approach for TON patients with high sphenoidal pneumatisation and without supersphenoid-ethmoid cellulae.
authors.affiliation: Allergy and Cancer Center, Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Fenghong
authors.initials: F
authors.lastname: Chen
authors.affiliation: Allergy and Cancer Center, Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Kejun
authors.initials: K
authors.lastname: Zuo
authors.affiliation: Department of Otolaryngology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
authors.forename: Shaoyan
authors.initials: S
authors.lastname: Feng
authors.affiliation: Allergy and Cancer Center, Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Jiebo
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Otolaryngology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
authors.forename: Yunping
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Allergy and Cancer Center, Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Shi
authors.affiliation: Allergy and Cancer Center, Otorhinolaryngology Hospital, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Huabin
authors.initials: H
authors.lastname: Li
keywords: Endoscopic technique; Optic nerve decompression; Traumatic optic neuropathy