874 Comparative Study on the Efficacy of Optic Nerve Decompression Through Pterional and Supraorbital Approaches in the Treatment of Progressive Completely Blind Traumatic Optic Neuropathy

INTRODUCTION: Traumatic optic neuropathy (TON) is a serious complication of craniomaxillofacial trauma that directly or indirectly damages the optic nerve and cause different degrees of visual impairment. The role of optic nerve decompression (OND) in treating TON remained inconclusive. METHODS: Patients with progressive completely blind TON treated with OND through pterional and supraorbital approach in our institute by one surgeon from September 2019 to June 2022 were retrospective reviewed in this study. Demographic information, trauma factors, interval between trauma and complete blind, interval between trauma and surgery, and preoperative CT findings were recorded. Hospitalization days and the postoperative visual acuity of patients in two groups were compared. RESULTS: There are 54 patients included in this study, 21 patients underwent OND through pterional approach, and the others underwent supraorbital approaches. Male patients are more common than female in both groups. Respectively, in groups of pterional and supraorbital approaches, the average hospitalization days were 9.8 ± 2.4 and 10.7 ± 2.9, the mean durations of follow-up are 20.1 ± 4.2 and 21.4 ± 3.1 months, respectively. The number of patients underwent pterional approach who improved their visual acuity to light perception and digit counting, respectively, is nine (42.9%) and three (14.3%). In group of supraorbital approach, the number is 9 (27.3%) and 6 (18.2%), respectively. The overall improvement rates of pterional and supraorbital approaches is 57.1% and 45.5%, and no significant difference was noted (P=0.40). CONCLUSIONS: Patients with progressive completely blind traumatic TON can benefit from OND. No significant difference was noted regarding to the improvement rates of OND through pterional and supraorbital approaches in the treatment of progressive completely blind TON in this study.