title: Post-traumatic optic neuropathy: our surgical and medical protocol.
abstract: Post-traumatic optic neuropathy (TON) is a rare, but very much feared event. It is a traumatic injury of the optic nerve at any level along its course (often inside the optic canal), with partial or total loss of visual acuity, temporarily or permanently. Until now, an univocal treatment strategy does not exist. The clinical records of 26 patients, treated from 2002 to 2013, were reviewed. The most frequent cause of injury was road traffic accident (63%), followed by iatrogenic damage, work injuries, sport or home accidents. All patients underwent pre-operative ophthalmological evaluation, neuro-imaging (angio-CT or angio-MRI scans) and systemic corticosteroid therapy. All patients required a surgical treatment, due to poor response to medical therapy; it consisted of an endonasal endoscopic decompression of the intracanalicular segment of the optic nerve, performed by removing the bony wall of the optical canal and releasing the perineural sheath. Improvement of visual acuity was reached in 65% of cases. No minor or major complication occurred intra- or post-operative, with a maximum follow-up time of 41 months. An improvement in visual acuity was achieved, although very limited in some cases, when surgery was performed as close as possible to the traumatic event. In the literature, there is no evidence-based data evaluating both of the two main treatment options (medical therapy versus surgical decompression), to state which is the gold standard in the treatment for TON. We discuss the pro and cons of our protocol: medical endovenous steroid treatment, within 8 h of injury, and endoscopic surgical decompression within 12-24 since the beginning of medical therapy, represent the best solution in terms of risk-benefit ratio for the patients.
authors.affiliation: Department of Otorhinolaryngology and Otology Surgery of the University of Padova, via Giustiniani 2, Padua, Italy. enzoemanuelli@libero.it.
authors.forename: E
authors.initials: E
authors.lastname: Emanuelli
authors.affiliation: Department of Otorhinolaryngology and Otology Surgery of the University of Padova and the Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bignami
authors.affiliation: Department of Otorhinolaryngology and Otology Surgery of the University of Padova and the Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Digilio
authors.affiliation: Department of Maxillofacial Surgery, University of Padova, Padova, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Fusetti
authors.affiliation: Department of Otorhinolaryngology and Otology Surgery, University of Padova, Padova, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Volo
authors.affiliation: Department of Otorhinolaryngology and Otology Surgery of the University of Padova and the Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Castelnuovo
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000150:complications*; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009901:Optic Nerve Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Boston protocol; Corticosteroids; Endoscopic decompression; PEV; Retrobulbar hemorrhage; TON