The sphenoidal sinus in optic nerve decompression

Optic foramen location on computed tomography

BACKGROUND

This study aimed to identify the location of the optic foramen in relation to the anterior sphenoid sinus wall, which is essential information for surgeons in planning and performing endoscopic transnasal surgery.

METHODS

Computed tomography scans of 200 orbits from 100 adult patients with no abnormalities were examined. The results included the location of the optic foramen in relation to the anterior sphenoid sinus wall and the distance between them, as well as the distance from the optic foramen and the anterior sphenoid sinus wall to the carotid prominence in the posterior sphenoid sinus.

RESULTS

The optic foramen was anterior to the anterior sphenoid sinus wall in 48.5% of orbits, and posterior in the remaining 51.5%. The mean distance from the optic foramen to the anterior sphenoid sinus wall was 3.82 ± 1.25 mm. The mean distances from the optic foramen and the anterior sphenoid sinus wall to the carotid prominence were 7.67 ± 1.73 and 7.95 ± 2.53 mm, respectively.

CONCLUSION

The optic foramen was anterior to the anterior wall of the sphenoid sinus in approximately half of the orbits examined in this study, and posterior in the remaining half. The mean distance from the optic foramen to the anterior sphenoid sinus wall of the sphenoid sinus was 3.82 ± 1.25 mm.

Orbital decompression for thyroid eye disease

The literature regarding orbital decompression for thyroid eye disease is vast, spanning multiple specialty areas including neurosurgery, head and neck, maxillofacial, and ophthalmic plastic surgery. Although techniques have advanced considerably over the more than 100 years during which this procedure has been performed, the 4 major approaches remain: transorbital, transcranial, transantral, and transnasal. The explosion in literature related to orbital decompression has mostly involved minor technical variations on broader surgical themes. The purpose of this review is to organize the major approaches in terms of bony anatomy and to contextualize variation in transdisciplinary techniques within a common conceptualization.

Extended applications of endoscopic sinus surgery and its reference to cranial base and pituitary fossa

Sinus surgery has the potential of allowing ENT surgeons to encroach the boundaries of our colleagues in ophthalmology and neurosurgery. The advent of nasal endoscope and lately powered instrumentation and computer-assisted navigational systems has avoided the use of the conventional and more radical approaches by the ENT surgeon for the treatment of inflammatory pathology or tumors of the orbit and skull base. As rhinologists have gained more experience in endoscopic surgery, more areas related to the orbit and the anterior skull base are accessible and surgery is safer.

Clinical manifestations and treatment outcome of optic neuropathy in thyroid-related orbitopathy

BACKGROUND AND OBJECTIVE

To investigate the incidence and outcome of optic neuropathy associated with thyroid-related orbitopathy.

PATIENTS AND METHODS

All patients diagnosed as having optic neuropathy associated with thyroid-related orbitopathy who underwent treatment for optic neuropathy between January 1, 1999, and March 1, 2003, were reviewed. Demographic and clinical data were extracted from the oculoplastic registry (electronic medical record).

RESULTS

Optic neuropathy occurred in 20 of 595 patients with thyroid-related orbitopathy (3.4%). All patients received systemic steroids, 7 patients received orbital steroid injections, and 2 patients were treated with orbital radiotherapy. Orbital decompression was performed in all 26 orbits. Visual acuity improved from a mean of 20/150 to 20/30 (P < .001). Color vision improved from a mean of 5.2/14 to 11/14 (P = .001). The afferent pupillary defect disappeared shortly after treatment for all but 1 case, and improved in all cases. Exophthalmos decreased from 26.4 +/- 2.5 to 21.5 +/- 2.1 mm (P< .001; 95% confidence interval, 3.8 to 5.7).

CONCLUSIONS

Optic neuropathy manifests rarely in patients with thyroid-related orbitopathy. Monitoring visual acuity or afferent pupillary response may be a reliable way of assessing and monitoring optic neuropathy. In this study, patients had improved visual acuity and optic nerve function after a combination of medical and surgical treatment.

Compartments of the adult parasellar region

In the infant the region lateral to the sella turcica which is traditionally termed the 'cavernous sinus' is composed of 3 individual compartments. The aim of this study was to demonstrate a similar compartmentation of the adult cavernous sinus and to identify and quantify the adipose bodies which are located within the compartments. The region of the cavernous sinus in 136 adults was analysed by microdissection and histology. We demonstrate that in 66% of the cavernous sinus in adults is composed of at least 2 compartments and in 22% it is made up of 3. Assimilating the renaming in infants we termed the compartments 'pterygopalatine', 'orbital' and 'lateral sellar'. The pterygopalatine and orbital compartments are connected with extracranial tissue spaces via the superior orbital fissure and contain characteristic adipose bodies. Exact topographic descriptions and measurements of the compartments and their adipose bodies are provided. Our study clearly defines compartmentation of the adult parasellar space in most individuals and thus changes the anatomical view of this space. The direct connection of 2 of these compartments with extracranial tissue spaces and the measurements of their adipose bodies are of interest for surgeons and neuroradiologists.