title: Timing of endoscopic surgical decompression in traumatic optic neuropathy: a systematic review of the literature.
abstract: Traumatic optic neuropathy (TON) represents a rare but devastating complication of closed head injuries. No accepted guidelines are available for medical and surgical management algorithms. A systematic review of the literature was performed to determine the optimal timing and candidacy for endoscopic surgical intervention.
  
  
  
  A systematic review of multiple databases was performed including Medline-Ovid, EMBASE, and PubMed. Data was extracted and patients stratified based on surgical delay from trauma (≤3 days, >3 days, ≤7 days, or >7 days) as well as preoperative and postoperative vision testing (no light perception [NLP]; light perception [LP]; hand motion [HM]; or finger counting [FC] or better).
  
  
  
  The literature review identified 24 studies meeting inclusion criteria. In the group of patients receiving surgery ≤3 days after the antecedent event, 57% (105/183) had visual improvement, whereas in the >7-days group 51% (145/283) of patients improved. In those with NLP preoperatively, 41% (172/411) saw improvement, whereas those with LP (89%), HM (93%), or FC (85%) fared better.
  
  
  
  The literature suggests that surgical intervention for TON is indicated despite delayed presentation, and is a better choice than no intervention at all. Patients with complete blindness on presentation (NLP) tend to have a poorer surgical outcome.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.
authors.forename: Sandeep S
authors.initials: SS
authors.lastname: Dhaliwal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.
authors.forename: Leigh J
authors.initials: LJ
authors.lastname: Sowerby
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Rotenberg
mesh_terms: D019299:Decompression, Surgical; D004724:Endoscopy; D006801:Humans; D009901:Optic Nerve Diseases / Q000601:surgery*; D013997:Time Factors
keywords: endoscopic sinus surgery; optic nerve decompression; optic nerve injury; optic neuropathy; surgical decompression