Yonsei Med J.  2005 Apr;46(2):300-304. 10.3349/ymj.2005.46.2.300.

Optic Nerve Injury Secondary to Endoscopic Sinus Surgery: an Analysis of Three Cases

• Kim JY
• Kim HJ
• Kim CH
• Lee JG
• Yoon JH

• KMID: 1734060
• DOI: http://doi.org/10.3349/ymj.2005.46.2.300

Abstract

Major orbital complications after the endoscopic sinus surgeries are rare and of these, optic nerve injury is one of the most serious. This study was to undertaken to analyze 3 cases of optic nerve injury after endoscopic sinus surgery. The three cases included one patient with a loss of visual acuity and visual field defect, and two patients with total blindness. In all cases, no improvement of visual acuity was observed despite treatment. It is important to frequently check the location and direction of the endoscope during surgery to avoid optic nerve injury. In addition, surgeons must have a precise knowledge of the detailed anatomy through cadaver dissections, an ability to interpret the PNS CT scan and experienced procedural surgical skills.

Keyword

Optic nerve injury; endoscopic sinus surgery

MeSH Terms

Adult
Blindness/etiology
Endoscopy/*adverse effects
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Optic Nerve Injuries/diagnosis/*etiology/radiography
Paranasal Sinuses/*surgery
Retrospective Studies
Tomography, X-Ray Computed
Vision Disorders/etiology
Visual Acuity
Visual Fields

Figure

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  Fig. 1 Visual field defect (dark area) was noted in the whole area, except in the small inferomedial portion of the field, on the day of surgery (A). The visual field defect (dark area) improved but an extensive visual field defect remained, except in the inferomedial portion of the field 8 days after sinus surgery (B) in Case 1.

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  Fig. 2 Axial MRI showing a defect of the superolateral wall of the right sphenoid sinus with an exposed optic nerve (A, white arrow). Coronal MRI showing high signal intensity above the internal carotid artery (B, white arrow), possibly due to an intraparenchymal hemorrhage in Case 1.

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  Fig. 3 Visual evoked potential test findings 8 days after sinus surgery. A flat wave for the left eye indicated complete loss of visual activity in Case 2.

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  Fig. 4 The loss of the fat line around the medial rectus muscle and enhanced signal intensity around the medial rectus and posterior to the optic nerve (white arrow) in T1 and T2-weighted MRIs in Case 2.

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  Fig. 5 Axial CT showing a small right medial wall fracture and a possible partial defect in the right optic nerve. A thick bony septa was seen in the ethmoid area (white arrow) in Case 3.

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  Fig. 6 Orbital MRI showing a mild enhancement of the posterior half of the right optic nerve sheath (white arrow) and a dark signal focus of medial rectus muscle near the right orbit apex in Case 3.

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