Endoscopic endonasal intracanalicular optic nerve decompression: how I do it.

Background: The endoscopic endonasal approach for optic nerve decompression is suited for the management of non-traumatic optic neuropathy but remains underreported, presumably due to transcranial approaches still being favoured at individual centres.

Method: The optic canal is approached endoscopically and transsphenoidally through the contralateral nostril. Its inferomedial wall is opened using an irrigated diamond drill, and neuronavigation is used to confirm anatomical bearings.

Conclusion: This technique provides rapid and easy access to the inferomedial aspect of the optic canal and nerve. Optic nerve decompression through this approach is associated with low morbidity and should be considered as an alternative to transcranial approaches.