[Optic nerve damage following craniocerebral trauma. A critical analysis of trans-ethmoid decompression of the optic nerve].

Over a period of 10 years 39 patients who suffered an optic nerve compression after a craniocerebral trauma underwent transethmoidal decompression surgery. The operation was performed bilaterally on 5 patients. Fifty per cent of the patients involved suffered a blunt head or brain injury, the others a brain concussion or space-occupying haemorrhage. At the side of optic nerve compression we found specific signs and symptoms, such as negative or sluggish direct light reaction of the pupil, a wound on the lateral side of the eyebrow, bleeding from the nose, eyelid haematoma, maximum of skull fractures and intracranial haematomas. Since the coincidence of radiological and intraoperative findings was only 67%, the ophthalmological findings such as lack of direct pupil reaction with preserved consensual light reaction or progressive loss of vision after a corresponding traumatic incident are our guideline for performing transethmoidal decompression of the optic nerve. In comparison with the results of conservative therapy as published in the literature, we achieved restitution of the visual function in about 10% more of the cases.