Long-term Outcomes Following Endoscopic Transnasal Surgery for Optic Neuropathy Due to Craniofacial Fibrous Dysplasia.

Abstract

OBJECTIVE:

To investigate the feasibility of endoscopic transnasal optic canal decompression (ETOCD) guided by a navigation surgical system (NSS) for vision recovery in patients with compressive optic neuropathy (CON) caused by craniofacial fibrous dysplasia (CFD), and to explore the underlying cause of visual impairment.

METHODS:

All patients underwent unilateral NSS-guided ETOCD and were followed up periodically for at least six months. Paired sample t-test and Pearson correlation analyses were used to compare continuous variables of the visual outcomes at the final review. A histopathological test of abnormal bone specimens was performed postoperatively.

RESULTS:

Thirty-four patients were finally included, and all surgeries were uneventful. The best corrected visual acuity (BCVA) (logMAR units) decreased from 1.29 ± 0.80 preoperatively to 0.97 ± 0.78 at the last follow-up (p = 0.0012), improving in 28 patients (82.35%). The absolute value of mean defect (MD) significantly decreased (p < 0.001). Color vision was impaired in 17 patients preoperatively and improved in 6 patients. BCVA at the last follow-up was significantly correlated with preoperative BCVA, onset time, preoperative retinal nerve fibril layer thickness, and MD (all p < 0.05). Among 34 patients, 26 had a blunt bony process near the anterior foot of the optic chiasm. Of the total patients, 73.53% patients experienced bony fiber recurrence 6 months or earlier after surgery without visual loss.

CONCLUSION:

NSS-guided ETOCD appeared to be safe and effective for visual recovery in patients with CON due to CFD, and early surgical intervention was critical for long-term recovery. Unbalanced compression of the optic canal by the blunt bony process may be a major cause of visual impairment.

LEVEL OF EVIDENCE:

4 Laryngoscope, 133:1857-1866, 2023.

• Authors: Min Wang, Senmiao Zhu, Bingyan Shen, Yenan Fang, Qiqi Xie, Qin Dai, Ziwen Chen, Xinyu Li, Wencan Wu
• Journal: The Laryngoscope (Laryngoscope) Vol. 133 Issue 8 Pg. 1857-1866 (08 2023) ISSN: 1531-4995 [Electronic] United States
• PMID: 37191080 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.

Topics

• Humans
• Craniofacial Fibrous Dysplasia (complications, surgery)
• Decompression, Surgical
• Endoscopy (adverse effects)
• Optic Nerve Diseases (etiology, surgery)
• Sphenoid Bone (surgery)
• Vision Disorders (surgery, complications)
• Feasibility Studies