[Strategies for endoscopic transnasal optic nerve decompression in the treatment of vision impairment associated with sphenoidal pneumosinus dilatans]

Abstract

Objective: To investigate the clinical characteristics, diagnostic and therapeutic experiences, and efficacy of endoscopic transnasal optic nerve decompression (ETOND) for vision impairment associated with sphenoidal pneumosinus dilatans (SPSD), a rare clinical entity. Methods: A retrospective analysis was conducted on 10 patients (3 females, 7 males; age range 10-56 years, including 5 adolescents) diagnosed with SPSD-related vision impairment at the Department of Otolaryngology, Chinese PLA General Hospital, from December 2022 to September 2024. Nine patients presented with painless vision impairment, while one reported periorbital pain. Prior to referral, 9 patients had been misdiagnosed with optic neuritis at other institutions and showed no response to initial intravenous glucocorticoid pulse therapy. All patients underwent ETOND after admission. Demographic data, medical history, and imaging findings (CT and MRI) were collected. Pre-and postoperative visual acuity was assessed and recorded; postoperative follow-ups were scheduled at 2 weeks (for short-term outcomes) and 3 months (for long-term outcomes). Results: Bilateral involvement occurred in up to 4/10 of cases in our group. Following ETOND, all 10 patients achieved visual improvement within 3 to 14 days postoperatively. Among the 3 patients who underwent bilateral decompression, 2 patients with sequential bilateral involvement showed visual recovery only in the recently affected eye (preoperative left eye visual acuity: 0.01 and 0.12; postoperative visual acuity: 0.3 and 0.2), while the contralateral eye remained with no light perception (NLP). The third patient with simultaneous bilateral involvement achieved bilateral visual improvement (preoperative: right eye 0.04, left eye counting fingers at 5 cm; postoperative: right eye 0.1, left eye 0.05). Long-term follow-up data confirmed stable visual recovery in all patients. No severe complications (e.g., orbital hematoma, permanent vision loss) were observed during both short-term and long-term follow-up. Conclusions: SPSD often presents as painless vision impairment, with a higher probability of involvement in both eyes.ETOND is an effective therapeutic modality for SPSD-induced vision impairment. Early surgical intervention is recommended for SPSD patients presenting with unilateral vision impairment to prevent irreversible optic nerve injury.