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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)

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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

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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