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
