caa a22 4500 606187723 CHVBK 20210128100842.0 cr unu---uuuuu 210128e20151101xx s 000 0 eng 10.1007/s00405-014-3408-5 doi (NATIONALLICENCE)springer-10.1007/s00405-014-3408-5 Post-traumatic optic neuropathy: our surgical and medical protocol [Elektronische Daten] [E. Emanuelli, M. Bignami, E. Digilio, S. Fusetti, T. Volo, P. Castelnuovo] Post-traumatic optic neuropathy (TON) is a rare, but very much feared event. It is a traumatic injury of the optic nerve at any level along its course (often inside the optic canal), with partial or total loss of visual acuity, temporarily or permanently. Until now, an univocal treatment strategy does not exist. The clinical records of 26 patients, treated from 2002 to 2013, were reviewed. The most frequent cause of injury was road traffic accident (63%), followed by iatrogenic damage, work injuries, sport or home accidents. All patients underwent pre-operative ophthalmological evaluation, neuro-imaging (angio-CT or angio-MRI scans) and systemic corticosteroid therapy. All patients required a surgical treatment, due to poor response to medical therapy; it consisted of an endonasal endoscopic decompression of the intracanalicular segment of the optic nerve, performed by removing the bony wall of the optical canal and releasing the perineural sheath. Improvement of visual acuity was reached in 65% of cases. No minor or major complication occurred intra- or post-operative, with a maximum follow-up time of 41months. An improvement in visual acuity was achieved, although very limited in some cases, when surgery was performed as close as possible to the traumatic event. In the literature, there is no evidence-based data evaluating both of the two main treatment options (medical therapy versus surgical decompression), to state which is the gold standard in the treatment for TON. We discuss the pro and cons of our protocol: medical endovenous steroid treatment, within 8h of injury, and endoscopic surgical decompression within 12-24 since the beginning of medical therapy, represent the best solution in terms of risk-benefit ratio for the patients. Springer-Verlag Berlin Heidelberg, 2014 TON nationallicence Boston protocol nationallicence PEV nationallicence Corticosteroids nationallicence Endoscopic decompression nationallicence Retrobulbar hemorrhage nationallicence Emanuelli E. Department of Otorhinolaryngology and Otology Surgery of the University of Padova, via Giustiniani 2, Padua, Italy aut Bignami M. Department of Otorhinolaryngology and Otology Surgery of the University of Padova and the Department of Otorhinolaryngology, University of Insubria, Varese, Italy aut Digilio E. Department of Otorhinolaryngology and Otology Surgery of the University of Padova and the Department of Otorhinolaryngology, University of Insubria, Varese, Italy aut Fusetti S. Department of Maxillofacial Surgery, University of Padova, Padova, Italy aut Volo T. Department of Otorhinolaryngology and Otology Surgery, University of Padova, Padova, Italy aut Castelnuovo P. Department of Otorhinolaryngology and Otology Surgery of the University of Padova and the Department of Otorhinolaryngology, University of Insubria, Varese, Italy aut European Archives of Oto-Rhino-Laryngology Springer Berlin Heidelberg 272/11(2015-11-01), 3301-3309 0937-4477 272:11<3301 2015 272 405 https://doi.org/10.1007/s00405-014-3408-5 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00405-014-3408-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Emanuelli E. Department of Otorhinolaryngology and Otology Surgery of the University of Padova, via Giustiniani 2, Padua, Italy aut NATIONALLICENCE 700 1- Bignami M. Department of Otorhinolaryngology and Otology Surgery of the University of Padova and the Department of Otorhinolaryngology, University of Insubria, Varese, Italy aut NATIONALLICENCE 700 1- Digilio E. Department of Otorhinolaryngology and Otology Surgery of the University of Padova and the Department of Otorhinolaryngology, University of Insubria, Varese, Italy aut NATIONALLICENCE 700 1- Fusetti S. Department of Maxillofacial Surgery, University of Padova, Padova, Italy aut NATIONALLICENCE 700 1- Volo T. Department of Otorhinolaryngology and Otology Surgery, University of Padova, Padova, Italy aut NATIONALLICENCE 700 1- Castelnuovo P. Department of Otorhinolaryngology and Otology Surgery of the University of Padova and the Department of Otorhinolaryngology, University of Insubria, Varese, Italy aut NATIONALLICENCE 773 0- European Archives of Oto-Rhino-Laryngology Springer Berlin Heidelberg 272/11(2015-11-01), 3301-3309 0937-4477 272:11<3301 2015 272 405