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J Neurol Surg A Cent Eur Neurosurg 2021; 82(05): 475-483
DOI: 10.1055/s-0040-1720991
Technical Note

Strategies for Optic Pathways Decompression for Extra-Axial Tumors or Intracranial Aneurysms: A Technical Note

Pier Paolo Mattogno    *
1   Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
,
Carmelo Lucio Sturiale    *
1   Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
,
Alessandro Rapisarda
1   Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
,
Alessandro Olivi
1   Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
,
Alessio Albanese
1   Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Abstract

Background Different types of skull base tumors and intracranial aneurysms may lead to compression of the optic pathways. Since most of them are biologically benign conditions, the first aim of surgery is preservation of optic nerves rather than the oncologic radicality.

Materials and methods Based on the progressive technical refinements coming from our institutional experience of optic nerve compression from aneurysms and extra-axial tumors, we analyzed the surgical steps to release nerves and chiasm during tumor debulking and aneurysm clipping.

Results We distinguished vascular and tumor lesions according to the main direction of optic nerve compression: lateral to medial, medial to lateral, inferior to superior, and anterior to posterior. We also identified four fundamental sequential maneuvers to release the optic nerve, which are (1) falciform ligament (FL) section, (2) optic canal unroofing, (3) anterior clinoid process drilling, and (4) optic strut removal. The FL section is always recommended when a gentle manipulation of the optic nerve is required. Optic canal unroofing is suggested in case of lateral-to-medial compression (i.e., clinoid meningiomas), medial-to-lateral compression (i.e., tuberculum sellae meningiomas), and inferior-to-superior compression (i.e., suprasellar lesions). Anterior clinoidectomy and optic strut removal may be necessary in case of lateral-to-medial compression from paraclinoid aneurysms or meningiomas.

Conclusions Preservation of the visual function is the main goal of surgery for tumors and aneurysms causing optic nerve compression. This mandatory principle guides the approach, the timing, and the technical strategy to release the optic nerve, and is principally based on the direction of the compression vector.

Keywords

optic nerve - optic pathways - decompression - falciform ligament - optic canal

* Alphabetically ordered first coauthors




Publication History

Received: 25 April 2020

Accepted: 25 August 2020

Article published online:
28 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Woodall MN, Alleyne Jr CH. Carotid-falciform optic neuropathy: microsurgical treatment. World Neurosurg 2017; 104: 372-375
    CrossrefPubMedGoogle Scholar
  • 2 Dolenc VV. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J Neurosurg 1985; 62 (05) 667-672
    CrossrefPubMedGoogle Scholar
  • 3 Fukuda H, Evins AI, Burrell JC, Iwasaki K, Stieg PE, Bernardo A. The meningo-orbital band: microsurgical anatomy and surgical detachment of the membranous structures through a frontotemporal craniotomy with removal of the anterior clinoid process. J Neurol Surg B Skull Base 2014; 75 (02) 125-132
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Korosue K, Heros RC. “Subclinoid” carotid aneurysm with erosion of the anterior clinoid process and fatal intraoperative rupture. Neurosurgery 1992; 31 (02) 356-359 , discussion 359–360
    CrossrefPubMedGoogle Scholar
  • 5 Chang DJ. The “no-drill” technique of anterior clinoidectomy: a cranial base approach to the paraclinoid and parasellar region. Neurosurgery 2009; 64 (03) ons96-ons105 , discussion ons105–ons106
    CrossrefPubMedGoogle Scholar
  • 6 Golub JS, Weber JD, Leach JL. et al. Feasibility of the ultrasonic bone aspirator in retrosigmoid vestibular schwannoma removal. Otolaryngol Head Neck Surg 2015; 153 (03) 427-432
    CrossrefPubMedGoogle Scholar
  • 7 Caporlingua A, Prior A, Cavagnaro MJ. et al. The intracranial and intracanalicular optic nerve as seen through different surgical windows: endoscopic versus transcranial. World Neurosurg 2019; 124: 522-538
    CrossrefPubMedGoogle Scholar
  • 8 Bernardo A, Evins AI, Mattogno PP, Quiroga M, Zacharia BE. The orbit as seen through different surgical windows: extensive anatomosurgical study. World Neurosurg 2017; 106: 1030-1046
    CrossrefPubMedGoogle Scholar
  • 9 Beer-Furlan A, Abi-Hachem R, Jamshidi AO, Carrau RL, Prevedello DM. Endoscopic trans-sphenoidal surgery for petroclival and clival meningiomas. J Neurosurg Sci 2016; 60 (04) 495-502
    PubMedGoogle Scholar
  • 10 Kong DS, Hong CK, Hong SD. et al. Selection of endoscopic or transcranial surgery for tuberculum sellae meningiomas according to specific anatomical features: a retrospective multicenter analysis (KOSEN-002). J Neurosurg 2018; 130 (03) 838-847
    CrossrefPubMedGoogle Scholar
  • 11 Zada G, Fredrickson VL, Wrobel BB. Extended endoscopic endonasal approach for resection of tuberculum sellae meningioma. Neurosurg Focus 2017; 43 (VideoSuppl2): V2
    CrossrefPubMedGoogle Scholar
  • 12 Ditzel Filho LF, Prevedello DM, Jamshidi AO. et al. Endoscopic endonasal approach for removal of tuberculum sellae meningiomas. Neurosurg Clin N Am 2015; 26 (03) 349-361
    CrossrefPubMedGoogle Scholar
  • 13 Lobo B, Zhang X, Barkhoudarian G, Griffiths CF, Kelly DF. Endonasal endoscopic management of parasellar and cavernous sinus meningiomas. Neurosurg Clin N Am 2015; 26 (03) 389-401
    CrossrefPubMedGoogle Scholar
  • 14 Almeida JP, Omay SB, Shetty SR. et al. Transorbital endoscopic eyelid approach for resection of sphenoorbital meningiomas with predominant hyperostosis: report of 2 cases. J Neurosurg 2018; 128 (06) 1885-1895
    CrossrefPubMedGoogle Scholar
  • 15 Silva MA, See AP, Dasenbrock HH, Patel NJ, Aziz-Sultan MA. Vision outcomes in patients with paraclinoid aneurysms treated with clipping, coiling, or flow diversion: a systematic review and meta-analysis. Neurosurg Focus 2017; 42 (06) E15
    CrossrefPubMedGoogle Scholar
  • 16 Sturiale CL, Marchese E, Puca A, Olivi A, Albanese A. Surgical treatment of posterior communicating artery aneurysms: hints and precautions for young cerebrovascular surgeons. J Neurol Surg A Cent Eur Neurosurg 2019; 80 (03) 205-212
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Kamide T, Tabani H, Safaee MM, Burkhardt JK, Lawton MT. Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms. J Neurosurg 2018; 129 (06) 1511-1521
    CrossrefPubMedGoogle Scholar
  • 18 Nanda A, Javalkar V. Microneurosurgical management of ophthalmic segment of the internal carotid artery aneurysms: single-surgeon operative experience from Louisiana State University, Shreveport. Neurosurgery 2011; 68 (02) 355-370 , discussion 370–371
    CrossrefPubMedGoogle Scholar
  • 19 Kobayashi S, Kyoshima K, Gibo H, Hegde SA, Takemae T, Sugita K. Carotid cave aneurysms of the internal carotid artery. J Neurosurg 1989; 70 (02) 216-221
    CrossrefPubMedGoogle Scholar
  • 20 Tabani H, Yousef S, Burkhardt JK, Gandhi S, Benet A, Lawton MT. Microsurgical clipping of an unruptured carotid cave aneurysm: 3-dimensional operative video. World Neurosurg 2017; 104: 1045.e3
    CrossrefPubMedGoogle Scholar
  • 21 Okudera H, Kobayashi S, Kyoshima K, Nitta J. Ring clip with laterally curved blades for carotid cave aneurysm. Neurosurgery 1996; 39 (03) 614-616
    PubMedGoogle Scholar
  • 22 Pamir MN, Belirgen M, Ozduman K, Kiliç T, Ozek M. Anterior clinoidal meningiomas: analysis of 43 consecutive surgically treated cases. Acta Neurochir (Wien) 2008; 150 (07) 625-635 , discussion 635–636
    CrossrefPubMedGoogle Scholar
  • 23 Sughrue M, Kane A, Rutkowski MJ, Berger MS, McDermott MW. Meningiomas of the anterior clinoid process: is it wise to drill out the optic canal?. Cureus 2015; 7 (09) e321
    PubMedGoogle Scholar
  • 24 Magill ST, Morshed RA, Lucas CG. et al. Tuberculum sellae meningiomas: grading scale to assess surgical outcomes using the transcranial versus transsphenoidal approach. Neurosurg Focus 2018; 44 (04) E9
    CrossrefPubMedGoogle Scholar
  • 25 Lu VM, Goyal A, Rovin RA. Olfactory groove and tuberculum sellae meningioma resection by endoscopic endonasal approach versus transcranial approach: a systematic review and meta-analysis of comparative studies. Clin Neurol Neurosurg 2018; 174: 13-20
    CrossrefPubMedGoogle Scholar
  • 26 Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM. Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 2008; 108 (04) 715-728
    CrossrefPubMedGoogle Scholar
  • 27 Prieto R, Pascual JM, Barrios L. Optic chiasm distortions caused by craniopharyngiomas: clinical and magnetic resonance imaging correlation and influence on visual outcome. World Neurosurg 2015; 83 (04) 500-529
    CrossrefPubMedGoogle Scholar
  • 28 Wannemuehler TJ, Rubel KE, Hendricks BK. et al. Outcomes in transcranial microsurgery versus extended endoscopic endonasal approach for primary resection of adult craniopharyngiomas. Neurosurg Focus 2016; 41 (06) E6
    CrossrefPubMedGoogle Scholar
  • 29 Couldwell WT. Transsphenoidal and transcranial surgery for pituitary adenomas. J Neurooncol 2004; 69 (1–3): 237-256
    CrossrefPubMedGoogle Scholar
  • 30 Youssef AS, Agazzi S, van Loveren HR. Transcranial surgery for pituitary adenomas. Neurosurgery 2005; 57 (01) 168-175 , discussion 168–175
    PubMedGoogle Scholar
  • 31 Pallini R, Fernandez E, Lauretti L. et al. Olfactory groove meningioma: report of 99 cases surgically treated at the Catholic University School of Medicine, Rome. World Neurosurg 2015; 83 (02) 219-31.e1-219-31.e3
    CrossrefPubMedGoogle Scholar