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J Neurol Surg B Skull Base 2013; 74(01): 020-038
DOI: 10.1055/s-0032-1329624
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Predictive Factors for Vision Recovery after Optic Nerve Decompression for Chronic Compressive Neuropathy: Systematic Review and Meta-Analysis

Andrew P. Carlson
1   Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States
,
Martina Stippler
1   Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States
,
Orrin Myers
2   Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States
› Author Affiliations
Further Information

Publication History

01 March 2012

08 June 2012

Publication Date:
26 November 2012 (online)

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Abstract

Objectives Surgical optic nerve decompression for chronic compressive neuropathy results in variable success of vision improvement. We sought to determine the effects of various factors using meta-analysis of available literature.

Design Systematic review of MEDLINE databases for the period 1990 to 2010.

Setting Academic research center.

Participants Studies reporting patients with vision loss from chronic compressive neuropathy undergoing surgery.

Main outcome measures Vision outcome reported by each study. Odds ratios (ORs) and 95% confidence intervals (CIs) for predictor variables were calculated. Overall odds ratios were then calculated for each factor, adjusting for inter study heterogeneity.

Results Seventy-six studies were identified. Factors with a significant odds of improvement were: less severe vision loss (OR 2.31[95% CI = 1.76 to 3.04]), no disc atrophy (OR 2.60 [95% CI = 1.17 to 5.81]), smaller size (OR 1.82 [95% CI = 1.22 to 2.73]), primary tumor resection (not recurrent) (OR 3.08 [95% CI = 1.84 to 5.14]), no cavernous sinus extension (OR 1.88 [95% CI = 1.03 to 3.43]), soft consistency (OR 4.91 [95% CI = 2.27 to 10.63]), presence of arachnoid plane (OR 5.60 [95% CI = 2.08 to 15.07]), and more extensive resection (OR 0.61 [95% CI = 0.4 to 0.93]).

Conclusions Ophthalmologic factors and factors directly related to the lesion are most important in determining vision outcome. The decision to perform optic nerve decompression for vision loss should be made based on careful examination of the patient and realistic discussion regarding the probability of improvement.

Keywords

optic nerve - optic nerve decompression - skull base meningioma - skull base surgery - vision loss
 

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