Mesquita Filho Paulo M, Prevedello Daniel M, Prevedello Luciano M, Ditzel Filho Leo F, Fiore Mariano E, Dolci Ricardo L, Buohliqah Lamia, Otto Bradley A, Carrau Ricardo L
Department of Neurosurgery, Passo Fundo City Hospital, Rio Grande do Sul, Brazil; Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
World Neurosurg. 2017 Aug;104:745-751. doi: 10.1016/j.wneu.2017.04.171. Epub 2017 May 17.
The optic canal is a bony channel that connects the anterior cranial fossa and orbit and contains the optic nerve and ophthalmic artery. It can be affected by several pathologies, leading to compression of the nerve nearby or inside the canal, leading to visual impairment. The usual technique to decompress the canal is through a craniotomy, but recently endoscopic endonasal approaches (EEAs) have surfaced as an interesting alternative due to direct access to the canal without the need for manipulation of neurovascular structures.
Six specimens were dissected. The right optic canal was drilled on the right side via the EEA, and the left optic canal was drilled via frontotemporal craniotomy. The amount of decompression was measured using a 3-dimensional reconstruction on computed tomography scans and compared.
The EEA generated an average of 267.8 (221-294) degrees of decompression in the anterior portion of the canal versus 258.3 (219-300) degrees of decompression in the posterior portion of the canal, whereas the craniotomy generated an average of 229.3 (101-289) degrees of decompression in the anterior portion of the canal versus 250.3 (76-300) degrees of decompression in the posterior portion of the canal. There was no significant difference statistically.
The decision for an approach for optic canal decompression should be based on the site of the pathology and localization of canal involvement. Both techniques are equivalent in terms of proportion of nerve decompression.
视神经管是连接前颅窝和眼眶的骨性管道，包含视神经和眼动脉。它可受多种病变影响，导致神经管附近或管内神经受压，进而引起视力损害。通常的神经管减压技术是通过开颅手术，但近来内镜鼻内入路（EEAs）作为一种有趣的替代方法出现，因为它可直接进入神经管，无需操作神经血管结构。
解剖了6个标本。右侧视神经管通过EEA在右侧进行钻孔，左侧视神经管通过额颞开颅手术进行钻孔。使用计算机断层扫描的三维重建测量减压量并进行比较。
EEA在神经管前部平均产生267.8（221 - 294）度的减压，在神经管后部平均产生258.3（219 - 300）度的减压；而开颅手术在神经管前部平均产生229.3（101 - 289）度的减压，在神经管后部平均产生250.3（76 - 300）度的减压。统计学上无显著差异。
视神经管减压方法的选择应基于病变部位和神经管受累的定位。两种技术在神经减压比例方面相当。
