title: Usefulness of Extradural Optic Nerve Decompression via Trans-Superior Orbital Fissure Approach for Treatment of Traumatic Optic Nerve Injury: Surgical Procedures and Techniques from Experience with 8 Consecutive Patients.
abstract: OBJECTIVE
  To describe our experience of extradural optic nerve decompression via the trans-superior orbital fissure approach for traumatic optic neuropathy (TON) and retrospectively analyze its advantages and pitfalls.
  
  
  METHODS
  Between September 2009 and August 2014, 8 consecutive patients with TON underwent extradural optic canal decompression via the trans-superior orbital fissure approach. We retrospectively reviewed medical charts, radiologic findings, surgical techniques, complications, and final surgical results.
  
  
  RESULTS
  All 8 patients presented with visual disturbance caused by head injury; 2 patients had no light perception, 6 had light perception, and 2 had ophthalmoplegia. All patients underwent extradural optic canal decompression and high-dose steroid administration within 24 hours after injury. Postoperative visual acuity on discharge was improved in 6 patients and unchanged in 2. The 2 patients with ophthalmoplegia gradually recovered by 3 months after operation. The postoperative outcome was good recovery in 7 patients and moderate disability in 1 patient. There were no complications related to the surgical procedure.
  
  
  CONCLUSIONS
  Emergent optic canal release has been recommended in patients with TON. The advantage of the extradural optic canal decompression via the trans-superior orbital fissure approach is easy identification of the optic canal after partial removal of the anterior clinoid process, resulting in fewer surgical complications. In addition, this procedure can achieve intraorbital decompression if necessary. We recommend this modified approach with mini-peeling as a safe and reliable procedure in patients with TON.
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan. Electronic address: naotani@ndmc.ac.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Otani
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Wada
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Fujii
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Terushige
authors.initials: T
authors.lastname: Toyooka
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Kohsuke
authors.initials: K
authors.lastname: Kumagai
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ueno
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tomura
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Arata
authors.initials: A
authors.lastname: Tomiyama
authors.affiliation: Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Nakao
authors.affiliation: Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mori
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D019299:Decompression, Surgical / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D020221:Optic Nerve Injuries / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D016896:Treatment Outcome
keywords: Extradural optic canal decompression; Skull base; Surgical results; Traumatic optic neuropathy