2026 Proffered Presentations
S220: COMPLICATION RATES AND FUNCTIONAL OUTCOMES FOLLOWING ENDOSCOPIC OPTIC NERVE DECOMPRESSION FOR NON-TRAUMATIC OPTIC NEUROPATHY: A SINGLE-ARM META-ANALYSIS
Khushal Gupta, MBBS1; Michael Karsy, MD, PhD, MSc, FAANS, FCNS2; 1Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Medical College; 2University of Michigan Health
Introduction: Non-traumatic optic neuropathy (NTON) represents a heterogeneous group of conditions often caused by compressive skull base lesions. Endoscopic optic nerve decompression (EOND) has been adopted as a minimally invasive option to improve visual outcomes, but reported complication rates and functional recovery vary across studies. We conducted a systematic review and meta-analysis to clarify the safety and effectiveness of EOND in NTON.
Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science was performed through April 2025, following PRISMA guidelines. Eligible studies included patients with NTON undergoing EOND, with a minimum cohort size of three patients. Etiologies included compressive lesions such as tuberculum sellae meningiomas, optic canal meningiomas, and fibrous dysplasia. Traumatic optic neuropathy, thyroid eye disease, and isolated case reports were excluded. Data extraction was conducted independently by two reviewers. Pooled estimates were calculated using a random-effects model with inverse variance weighting and Freeman–Tukey double arcsine transformation for proportions. Primary outcomes included complication rates and functional recovery. “Optic nerve recovery” was defined variably across studies, most commonly as improvement in visual acuity, visual fields, or optical coherence tomography (OCT) parameters. Visual field improvement and overall visual improvement were analyzed separately. Heterogeneity was quantified using I² statistics, and prediction intervals were provided to reflect the range of expected outcomes in future populations.
Results: Seventeen studies comprising 913 patients met inclusion criteria. Complication rates were exceedingly low: across 246 patients from eight studies, only a single adverse event was reported, precluding meaningful pooled analysis and highlighting the excellent safety profile of EOND for NTON.
Functional outcomes were more widely reported. Optic nerve recovery, variably defined across 14 studies (309 patients), demonstrated a pooled recovery rate of 79% (95% CI: 65–90%), though heterogeneity was high (I² = 84.7%), with a wide prediction interval (25–100%). Visual field improvement was reported in seven studies (238 patients), with a pooled rate of 70% (95% CI: 51–87%; I² = 86.4%). Overall visual improvement was reported in five studies (87 patients), with a pooled rate of 57% (95% CI: 38–75%; I² = 59.4%).
Conclusion: Endoscopic optic nerve decompression for non-traumatic optic neuropathy appears to be safe, with extremely low complication rates, and is associated with meaningful functional recovery in most patients. Variability in outcome definitions and patient selection across studies highlights the need for standardized reporting of visual endpoints. Future multicenter prospective studies with uniform metrics (visual acuity, fields, OCT) are warranted to refine patient selection and optimize surgical benefit.
