Timing of endoscopic surgical decompression in traumatic optic neuropathy: a systematic review of the literature.

Abstract

BACKGROUND:

Traumatic optic neuropathy (TON) represents a rare but devastating complication of closed head injuries. No accepted guidelines are available for medical and surgical management algorithms. A systematic review of the literature was performed to determine the optimal timing and candidacy for endoscopic surgical intervention.

METHODS:

A systematic review of multiple databases was performed including Medline-Ovid, EMBASE, and PubMed. Data was extracted and patients stratified based on surgical delay from trauma (≤3 days, >3 days, ≤7 days, or >7 days) as well as preoperative and postoperative vision testing (no light perception [NLP]; light perception [LP]; hand motion [HM]; or finger counting [FC] or better).

RESULTS:

The literature review identified 24 studies meeting inclusion criteria. In the group of patients receiving surgery ≤3 days after the antecedent event, 57% (105/183) had visual improvement, whereas in the >7-days group 51% (145/283) of patients improved. In those with NLP preoperatively, 41% (172/411) saw improvement, whereas those with LP (89%), HM (93%), or FC (85%) fared better.

CONCLUSION:

The literature suggests that surgical intervention for TON is indicated despite delayed presentation, and is a better choice than no intervention at all. Patients with complete blindness on presentation (NLP) tend to have a poorer surgical outcome.

• Authors: Sandeep S Dhaliwal, Leigh J Sowerby, Brian W Rotenberg
• Journal: International forum of allergy & rhinology (Int Forum Allergy Rhinol) Vol. 6 Issue 6 Pg. 661-7 (06 2016) ISSN: 2042-6984 [Electronic] United States
• PMID: 26782715 (Publication Type: Journal Article, Review, Systematic Review)
• Copyright: © 2016 ARS-AAOA, LLC.

Topics

• Decompression, Surgical
• Endoscopy
• Humans
• Optic Nerve Diseases (surgery)
• Time Factors