To explore the feasibility and efficacy of optic nerve extended decompression through neuroendoscopic transethmoidal-sphenoidal approach in the treatment of traumatic optic neuropathy (TON).

A retrospective analysis was performed on the clinical data of 43 patients of TON who were consecutively admitted and treated at the Department of Neurosurgery, the Affiliated Li Hui Li Hospital of Ningbo University from March 2018 to October 2022. The optic nerves of 24 patients(control group) were decompressed through neuroendoscopic transethmoidal-sphenoidal approach, whereas optic nerves of 19 patients (experimental group) were dealt with extended decompression through optic strut grinding. The duration of operation, intraoperative blood loss and hospitalization and so on were compared between the two groups. The efficacy of treatment was evaluated based on the visual change. Safety of treatment was determined based on the occurrence of postoperative complications.

The duration of operation in control group ranged from 56.3 min to 103.5 min (mean: 76.6±23.4 min), which was significantly different from that in experimental group (range: 75.1-121.6 min, mean: 93.2±17.9 min) (t=2.55, P=0.009). The intraoperative blood loss and hospitalization exhibited no statistical difference between the two groups (both P>0.05). Of 24 cases in the control group, there was no light perception in 6 cases, light perception in 10, hand motion in 6 and counting fingers in 2 before operation. At 3 months post operation, the results showed no light perception in 5, light perception in 7, hand motion in 7, counting fingers in 3 and Log MAR≥0.02 in 2. Of 19 cases in the experimental group, there was no light perception in 4 cases, light perception in 7, hand motion in 6 and counting fingers in 2 before operation. At 3 months post operation, the results showed no light perception in 3, light perception in 4, hand motion in 3, counting fingers in 6 and Log MAR≥0.02 in 3. The visual acuity of 9 patients in control group improved and that of 13 patients in experimental group improved. The proportion of efficacy of optic nerve extended decompression in the treatment of TON was significantly different from that of decompression through neuroendoscopic transethmoidal-sphenoidal approach (χ²=4.06, P=0.036). No surgical complications such as cerebrospinal fluid rhinorrhea, internal carotid artery injury or anosmia occurred in either group.

Optic nerve extended decompression by optic strut grinding with neuroendoscopic transethmoidal-sphenoidal approach seems to be more effective for the treatment of TON compared with the ordinary optic nerve decompression, and this operative method is also safe.

Optic nerve injuries; Natural orifice endoscopic surgery; Treatment outcome; Optic nerve extended decompression; Optic strut grinding