Download PDF
Skull Base 2006; 16(3): 145-155
DOI: 10.1055/s-2006-949517
ORIGINAL ARTICLE

Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Optic Nerve Decompression for Orbitofrontal Fibrous Dysplasia: Recent Development of Surgical Technique and Equipment

Takumi Abe1 , Kaneshige Satoh2 , Akira Wada1
  • 1Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan
  • 2Department of Plastic Surgery, Showa University School of Medicine, Tokyo, Japan
Further Information

Publication History

Publication Date:
21 August 2006 (online)

    Permissions and Reprints

ABSTRACT

Objectives: Orbitofrontal fibrous dysplasia often involves the bony orbit and optic canal. Although fibrous dysplasia reportedly produces compression of the optic nerve leading to visual disturbances, optic nerve decompression in patients without clinical signs of optic neuropathy remains controversial. We describe the recent development of surgical techniques and equipment for optic nerve decompression in orbitofrontal fibrous dysplasia. Methods: Optic nerve decompression was performed prophylactically for five patients and therapeutically for one patient using the transcranial extradural route. A high-speed drill and continuous suction-irrigation system has been used in five patients since 1998, and an ultrasonic bone curette in two patients since 2004. Results: The continuous suction-irrigation system was particularly effective for decreasing heat transfer and thus preventing thermal injury to the optic nerve from the high-speed drill. The ultrasonic bone curette was also effective, allowing bone removal with minimal pressure from the tip of the handpiece and without catching cotton pledgets or damaging surrounding tissues. Orbital dystopias and craniofacial deformities induced by fibrous dysplasia were also successfully corrected. Postoperatively, disturbance in visual function was present in only two patients. Mean follow-up period was 4.9 years. Conclusions: This equipment may contribute to the development of new modalities for optic nerve decompression in orbitofrontal fibrous dysplasia.

KEYWORDS

Fibrous dysplasia - optic nerve decompression - suction-irrigation system - ultrasonic bone curette

REFERENCES

  • 1 Chen Y-R, Breidahl A, Chang C-N. Optic nerve decompression in fibrous dysplasia: indications, efficacy, and safety.  Plast Reconstr Surg. 1997;  99 22-30
    CrossrefPubMedSearch in Google Scholar
  • 2 Liakos G M, Walker C B, Carruth JAS. Ocular complications in craniofacial fibrous dysplasia.  Br J Ophthalmol. 1979;  63 611-616
    PubMedSearch in Google Scholar
  • 3 Papadopoulos M C, Casey A T, Powell M. Craniofacial fibrous dysplasia complicated by acute, reversible visual loss: report of two cases.  Br J Neurosurg. 1998;  12 159-161
    CrossrefPubMedSearch in Google Scholar
  • 4 Edgerton M T, Persing J A, Jane J A. The surgical treatment of fibrous dysplasia with emphasis on recent contributions from cranio-maxillo-facial surgery.  Ann Surg. 1985;  202 459-479
    PubMedSearch in Google Scholar
  • 5 Katz B J, Nerad J A. Ophthalmic manifestations of fibrous dysplasia: a disease of children and adults.  Ophthalmology. 1998;  105 2207-2215
    CrossrefPubMedSearch in Google Scholar
  • 6 Sassin J F, Rosenberg R N. Neurological complications of fibrous dysplasia of the skull.  Arch Neurol. 1968;  18 363-369
    PubMedSearch in Google Scholar
  • 7 Kurimoto M, Endo S, Onizuka K, Akai T, Takaku A. Extradural optic nerve decompression for fibrous dysplasia with a favorable visual outcome.  Neurol Med Chir (Tokyo). 1996;  36 102-105
    PubMedSearch in Google Scholar
  • 8 Ricalde P, Horswell B B. Craniofacial fibrous dysplasia of the fronto-orbital region: a case series and literature review.  J Oral Maxillofac Surg. 2001;  59 157-168
    CrossrefPubMedSearch in Google Scholar
  • 9 Yavuzer R, Bone H, Jackson I T. Fronto-orbital fibrous dysplasia.  Orbit. 2000;  19 119-128
    CrossrefPubMedSearch in Google Scholar
  • 10 Moore A T, Buncic J R, Munro J R. Fibrous dysplasia of the orbit in childhood: clinical features and management.  Ophthalmology. 1985;  92 12-20
    PubMedSearch in Google Scholar
  • 11 Arroyo J G, Lessell S, Montgomery W W. Steroid-induced visual recovery in fibrous dysplasia.  J Clin Neuroophthalmol. 1991;  11 259-261
    PubMedSearch in Google Scholar
  • 12 Bocca G, de Vries J, Cruyberg JRM, Boers GHJ, Monnens LAH. Optic neuropathy in McCune-Albright syndrome: an indication for aggressive treatment.  Acta Paediatr. 1998;  87 599-600
    CrossrefPubMedSearch in Google Scholar
  • 13 Lee J S, FitzGibbon E, Butman J A et al.. Normal vision despite narrowing of the optic canal in fibrous dysplasia.  N Engl J Med. 2002;  347 1670-1676
    CrossrefPubMedSearch in Google Scholar
  • 14 Posnik J C, Wells M D, Drake J M, Buncic J R, Armstrong D. Childhood fibrous dysplasia presenting as blindness: a skull base approach for resection and immediate reconstruction.  Pediatr Neurosurg. 1993;  19 260-266
    PubMedSearch in Google Scholar
  • 15 Harris W H, Dudley Jr H R, Barry R J. The natural history of fibrous dysplasia. An orthopaedic, pathological, and roentgenographic study.  J Bone Joint Surg Am. 1962;  44A 207-233
    PubMedSearch in Google Scholar
  • 16 Leeds N, Seaman W B. Fibrous dysplasia of the skull and its differential diagnosis.  Radiology. 1962;  78 570-582
    PubMedSearch in Google Scholar
  • 17 Schwartz D T, Alpert M. The malignant transformation of fibrous dysplasia.  Am J Med. 1962;  32 393-403
    CrossrefPubMedSearch in Google Scholar
  • 18 Weisman J S, Hepler R S, Vinters H V. Reversible visual loss caused by fibrous dysplasia.  Am J Ophthalmol. 1990;  110 244-249
    PubMedSearch in Google Scholar
  • 19 Michael C B, Lee A G, Patrinely J R, Stal S, Blacklock J B. Visual loss associated with fibrous dysplasia of the anterior skull base. Case report and review of the literature.  J Neurosurg. 2000;  92 350-354
    PubMedSearch in Google Scholar
  • 20 Lüdecke D K, Treige W. Pressure-irrigation-suction system. Technical note.  Acta Neurochir (Wien). 1982;  66 123-126
    CrossrefPubMedSearch in Google Scholar
  • 21 Kamiyama H, Abe H, Nomura M, Saito H, Yasui N. Acute stage operations for cerebral aneurysms, intracerebral hematomas, arterio-venous malformation high pressure irrigation and suction system [in Japanese].  Surgery for Cerebral Stroke. 1988;  16 282-286
    PubMedSearch in Google Scholar
  • 22 Hadeishi H, Suzuki A, Yasui N, Satou Y. Anterior clinoidectomy and opening of the internal auditory canal using an ultrasonic bone curette.  Neurosurgery. 2003;  52 867-871
    CrossrefPubMedSearch in Google Scholar
  • 23 Nakagawa H, Uchikado H, Kim S D, Inoue T, Mizuno J. Ultrasonic bone curettes in spinal surgery.  Int Congr Ser. 2004;  1259 445-449
    CrossrefPubMedSearch in Google Scholar
  • 24 Abe T, Sato K, Otsuka T et al.. Optic nerve decompression for orbitofrontal fibrous dysplasia.  Skull Base. 2002;  12 145-153
    CrossrefPubMedSearch in Google Scholar
  • 25 Kurokawa Y, Sohma T, Tsuchita H, Kitami K, Suzuki S, Sohma K. Hemorrhage into fibrous dysplasia following minor head injury-effective decompression for the ophthalmic artery and optic nerve.  Surg Neurol. 1989;  32 421-426
    CrossrefPubMedSearch in Google Scholar
  • 26 Bland L I, Marchese M J, McDonald J V. Acute monocular blindness secondary to fibrous dysplasia of the skull: a case report.  Ann Ophthalmol. 1992;  24 263-266
    PubMedSearch in Google Scholar
  • 27 Saito K, Suzuki Y, Nehashi K, Sugita K. Unilateral extradural approach for bilateral optic canal release in a patient with fibrous dysplasia.  Surg Neurol. 1990;  34 124-128
    CrossrefPubMedSearch in Google Scholar
  • 28 Papay F A, Morales Jr L, Flaharty P et al.. Optic nerve decompression in cranial base fibrous dysplasia.  J Craniofac Surg. 1995;  6 5-10
    CrossrefPubMedSearch in Google Scholar
  • 29 Osguthorpe J D, Gudeman S K. Orbital complications of fibrous dysplasia.  Otolaryngol Head Neck Surg. 1986;  97 403-405
    PubMedSearch in Google Scholar
  • 30 Finney H L, Roberts T S. Fibrous dysplasia of the skull with progressive cranial nerve involvement.  Surg Neurol. 1976;  6 341-343
    PubMedSearch in Google Scholar
  • 31 Edelstein C, Goldberg R A, Rubino G. Unilateral blindness after ipsilateral prophylactic transcranial optic canal decompression for fibrous dysplasia.  Am J Ophthalmol. 1998;  126 469-471
    CrossrefPubMedSearch in Google Scholar
  • 32 Chen Y-R, Fairholm D. Fronto-orbito-sphenoidal fibrous dysplasia.  Ann Plast Surg. 1985;  15 190-203
    CrossrefPubMedSearch in Google Scholar
  • 33 Matthews L S, Hirsch C. Temperature measured in human cortical bone when drilling.  J Bone Joint Surg Am. 1972;  54A 297-308
    PubMedSearch in Google Scholar
  • 34 Toews A R, Bailey J V, Townsend HGG, Barber S M. Effect of feed rate and drill speed on temperatures in equine cortical bone.  Am J Vet Res. 1999;  60 942-944
    PubMedSearch in Google Scholar
  • 35 Iyer S, Weiss C, Mehta A. Effects of drill speed on heat production and the rate and quality of bone formation in dental implant osteotomies: Part I-Relationship between drill speed and heat production.  Int J Prosthodont. 1997;  10 411-414
    PubMedSearch in Google Scholar

Takumi AbeM.D. Ph.D. 

Department of Neurosurgery, Showa University School of Medicine

5-8 Hatanodai 1, Shinagawa-ku, Tokyo 142-8666, Japan

Email: takumi@med.showa-u.ac.jp