The therapeutic efficacy of endoscopic optic nerve decompression and its effects on the prognoses of 96 cases of traumatic optic neuropathy

J Trauma Acute Care Surg. 2012 May;72(5):1350-5. doi: 10.1097/TA.0b013e3182493c70.

Abstract

Background: Traumatic optic neuropathy (TON) is an important cause of severe loss of vision due to blunt or penetrating head trauma. The pathogenesis of TON remains unclear, and there are several potential causes for the observed loss in vision. Endoscopic optic nerve decompression (EOND) has been reported to improve the visual prognosis in TON cases, but its efficacy remains controversial. It is important to investigate the therapeutic efficacy of EOND in the treatment of TON and to evaluate the relevant prognostic factors.

Methods: A retrospective study was conducted to analyze the clinical characteristics and prognoses of 96 TON cases. The χ(2) test and multiple logistic regression analyses were used to evaluate potential prognostic factors.

Results: : The overall rate of EOND effectiveness was 40.6% (39 of 96). A significantly higher effective rate (83.3%) was observed for patients with light perception compared with those without light perception (26.4%, p < 0.05). Univariate and multiple logistic regression analyses identified three variables (no light perception, undergoing EOND 3 days after trauma, and hemorrhage within the ethmoid and/or sphenoid sinus) that were significantly associated with unrecovered visual acuity. Age, loss of consciousness, optic canal fracture, preoperative steroid megadose treatment, and optic nerve sheath incision were all factors that showed no significant correlation with therapeutic efficacy. However, patients with fractures in a single medial wall of the optic canal appeared to have better prognoses than patients with multiple fractures or those with a single fracture in a lateral wall.

Conclusions: The overall therapeutic efficacy of EOND for the treatment of TON is far from satisfactory, especially for patients without light perception. The factors that impact TON prognoses are complex and may be interrelated. The indication for EOND must be individualized.

Level of evidence: III, epidemiological study.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Blindness / epidemiology
  • Blindness / etiology
  • Blindness / prevention & control*
  • Child
  • China / epidemiology
  • Decompression, Surgical / methods*
  • Endoscopy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Optic Nerve / physiopathology
  • Optic Nerve / surgery*
  • Optic Nerve Injuries / complications
  • Optic Nerve Injuries / diagnosis
  • Optic Nerve Injuries / surgery*
  • Prognosis
  • Retrospective Studies
  • Trauma Severity Indices
  • Treatment Outcome
  • Visual Acuity
  • Young Adult