Endoscopic Endonasal Optic Nerve Decompression in Children Younger Than 2 Years Old with Congenital Optic Canal Stenosis: Illustrative Cases

Overview

Journal J Neurosurg Case Lessons

Specialty Neurology

Date 2024 Jul 8

PMID 38976922

Authors

Peter H Yang

John S Schneider

Michael R Chicoine

Albert H Kim

David D Limbrick

Affiliations

Soon will be listed here.

Abstract

Background: Congenital optic canal stenosis causing compressive optic neuropathy is a rare disorder that presents unique diagnostic and treatment challenges. Endoscopic endonasal optic nerve decompression (EOND) has been described for optic nerve compression in adults and adolescents but has never been reported for young children without pneumatized sphenoid sinuses. The authors describe preoperative and intraoperative considerations for three patients younger than 2 years of age with congenital optic canal stenosis due to genetically confirmed osteopetrosis or chondrodysplasia.

Observations: Serial ophthalmological examinations, with a particular focus on object tracking ability, fundoscopic examination, and visual evoked potential trends in preverbal children, are important for detecting progressive optic neuropathy. The lack of pneumatization of the sphenoid sinus presents unique challenges and requires the surgical creation of a sphenoid sinus with the use of neuronavigation to determine the limits of bony exposure given the lack of easily identifiable anatomical landmarks such as the opticocarotid recess. There were no perioperative complications.

Lessons: EOND for congenital optic canal stenosis is safe and technically feasible even given the lack of pneumatization of the sphenoid sinus in young patients. The key operative step is surgically creating the sphenoid sinus through careful bony removal with the aid of neuronavigation. https://thejns.org/doi/10.3171/CASE23559.

References

Scharf R, Scharf G, Stroustrup A . Developmental Milestones. Pediatr Rev. 2016; 37(1):25-37. DOI: 10.1542/pir.2014-0103. View

Pletcher S, Metson R . Endoscopic optic nerve decompression for nontraumatic optic neuropathy. Arch Otolaryngol Head Neck Surg. 2007; 133(8):780-3. DOI: 10.1001/archotol.133.8.780. View

Behbahani M, Fernando S, Peng S, Fernandez L, Hajnas N, Sharma S . Endoscopic endonasal optic nerve decompression: treatment of fibrous dysplasia in a pediatric population. J Neurosurg Pediatr. 2022; 31(2):179-185. DOI: 10.3171/2022.9.PEDS22313. View

Li H, Zhou B, Shi J, Cheng L, Wen W, Xu G . Treatment of traumatic optic neuropathy: our experience of endoscopic optic nerve decompression. J Laryngol Otol. 2008; 122(12):1325-9. DOI: 10.1017/S0022215108002296. View

Jang Y, Kim S . Pneumatization of the sphenoid sinus in children evaluated by magnetic resonance imaging. Am J Rhinol. 2000; 14(3):181-5. DOI: 10.2500/105065800782102771. View

Prager T, Zou Y, Jensen C, Fraley J, Anderson R, Heird W . Evaluation of methods for assessing visual function of infants. J AAPOS. 1999; 3(5):275-82. DOI: 10.1016/s1091-8531(99)70023-6. View

Berhouma M, Jacquesson T, Abouaf L, Vighetto A, Jouanneau E . Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature. Neurosurg Focus. 2014; 37(4):E19. DOI: 10.3171/2014.7.FOCUS14303. View

Baba T, Minamida Y, Mikama T, Koyanagi I, Houkin K . Entrapment neuropathy of the optic nerve due to hyperostosis associated with congenital anemia. J Neurosurg. 2005; 103(5):917-9. DOI: 10.3171/jns.2005.103.5.0917. View

Bulters D, Shenouda E, Evans B, Mathad N, Lang D . Visual recovery following optic nerve decompression for chronic compressive neuropathy. Acta Neurochir (Wien). 2009; 151(4):325-34. DOI: 10.1007/s00701-009-0192-x. View

10.

Zheng X, Xu G, Zhang K, Liang R, Yan W, Tian P . Assessment of Human Visual Acuity Using Visual Evoked Potential: A Review. Sensors (Basel). 2020; 20(19). PMC: 7582995. DOI: 10.3390/s20195542. View

11.

Sun J, Cai X, Zou W, Zhang J . Outcome of Endoscopic Optic Nerve Decompression for Traumatic Optic Neuropathy. Ann Otol Rhinol Laryngol. 2020; 130(1):56-59. DOI: 10.1177/0003489420939594. View

12.

Szolar D, Preidler K, Ranner G, Braun H, Kugler C, Wolf G . The sphenoid sinus during childhood: establishment of normal developmental standards by MRI. Surg Radiol Anat. 1994; 16(2):193-8. DOI: 10.1007/BF01627594. View

13.

Luxenberger W, Stammberger H, Jebeles J, Walch C . Endoscopic optic nerve decompression: the Graz experience. Laryngoscope. 1998; 108(6):873-82. DOI: 10.1097/00005537-199806000-00016. View

14.

Levin L, Beck R, Joseph M, Seiff S, Kraker R . The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study. Ophthalmology. 1999; 106(7):1268-77. DOI: 10.1016/s0161-6420(99)00707-1. View

15.

Yang Q, Zhang G, Liu X, Ye J, Li Y . 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; 72(5):1350-5. DOI: 10.1097/TA.0b013e3182493c70. View