• DOI:10.1227/01.NEU.0000254440.02736.E3
• Corpus ID: 19550908

LONG‐TERM OUTCOME OF OPTIC NERVE ENCASEMENT AND OPTIC NERVE DECOMPRESSION IN PATIENTS WITH FIBROUS DYSPLASIA: RISK FACTORS FOR BLINDNESS AND SAFETY OF OBSERVATION

@article{Cutler2006LONGTERMOO,
  title={LONG‐TERM OUTCOME OF OPTIC NERVE ENCASEMENT AND OPTIC NERVE DECOMPRESSION IN PATIENTS WITH FIBROUS DYSPLASIA: RISK FACTORS FOR BLINDNESS AND SAFETY OF OBSERVATION},
  author={Carolee M Cutler and Janice S. Lee and John A. Butman and Edmond J FitzGibbon and Marilyn H. Kelly and Beth A. Brillante and Penelope P. Feuillan and Pamela Gehron Robey and Craig R. Dufresne and Michael T Collins},
  journal={Neurosurgery},
  year={2006},
  volume={59},
  pages={1011–1018}
}

• Carolee M Cutler, Janice S. Lee, +7 authors M. Collins
• Published 1 November 2006
• Medicine
• Neurosurgery

OBJECTIVEFibrous dysplasia (FD) of bone may occur solely as a skeletal condition or it may occur in association with extraskeletal manifestations, including growth hormone (GH) excess. Uncertainty exists as to the management of FD involving the optic nerves. In an effort to clarify management, the authors studied a large population of patients. METHODSOne hundred four patients underwent an evaluation that includedreview of records, endocrine testing, cranial computed tomography, and neuro-ophthalmological examination. RESULTSNinety-one of 104 patients had craniofacial FD; complete records were available for 87 patients (174 nerves). Seventeen percent of the optic nerves were less than 50% encased, 22% were 50 to 99% encased, and 61% were 100% encased. Twelve percent of the nerves that were 100% encased showed evidence of optic neuropathy, but 88% did not. The group with optic neuropathy was not older than the group without. Patients with GH excess were significantly more likely to have nerves that were 100% encased (relative risk, 4.1; 95% confidence interval, 1.5–11.1; P = 0.0017) and to have optic neuropathy (relative risk, 3.8; 95% confidence interval, 2.0–7.1; P = 0.0019). Six prophylactic optic nerve decompressions were performed; in five patients, vision was stable after surgery, and one patient was blind after surgery. Thirteen interventional optic nerve decompression procedures were performed; six of the 13 patients showed some improvement and seven of the 13 showed no improvement or worsened vision. CONCLUSIONThe vast majority of optic nerves encased with FD do not exhibit symptoms of optic neuropathy and seem to be stable over time. GH excess is associated with increased risk of nerve encasement and optic neuropathy. Patients with craniofacial FD should be screened for GH excess, and optic nerve decompression should be performed only when there is objective evidence of progressive optic neuropathy.