“Apartment” Decompression for Saving Optic Nerve in Fronto-Orbital Fibrous Dysplasia: Strategy and Advantage

Background: During the past decades, surgical intervention is the primary treatment modality for fronto-orbital fibrous dysplasia involving optic nerve. However, controversy has surrounded the role of intra-canal decompression in a number of ways. Objective: Our philosophy of saving optic nerve is that treatment paradigms should be tailored to the individual. Herein, we describe three patients with fronto-orbital fibrous dysplasia involving optic nerve who underwent an “Apartment” sub-craniotomy strategy with navigation for intraorbital unit optic nerve decompression. Methods: From 2013 to 2015, three patients with fronto-orbital fibrous dysplasia were investigated in a retrospective fashion. They underwent unilateral intra-orbital optic nerve decompression with the help of “Apartment” strategy and navigation. The key procedures comprise preoperative simulation, fronto-orbital sub-craniotomy (like entering apartment), expanding cone-shaped surgical field, intra-orbital unit optic nerve decompression with navigation, correcting frontalorbital dystopias and deformities. Results: Both at the immediate postoperative period and the 3-12months follow-up, two cases showed improvement of visual acuity in the affected eye and one case showed no deterioration. Other ocular exams including eye movement were stable. Subsequent reconstruction yielded a satisfactory cosmetic result. No postoperative complications happened. Conclusion: In our philosophy, surgical management should be tailored to each patient, which is based on the most possible potential etiology. We consider the intra-orbital optic nerve decompression may be more feasible and safer with the help of “Apartment” strategy and navigation, especially for those with exophthalmos, orbital volume decreasing, and non-acute visual loss.