Is prophylactic decompression of the optic canal necessary in surgical correction of fronto-orbital fibrous dysplasia?: a review of 11 consecutive cases.

Fronto-orbital fibrous dysplasia is a disease characterized by frontal bossing and orbital dystopia. Simultaneous, prophylactic optic canal decompression remains controversial in the surgical correction of this condition. The authors review a series of 11 patients with fronto-orbital fibrous dysplasia. All patients underwent intracranial malformation excision. Concomitant optic canal decompression was carried out in 6 of 11 cases. Simultaneous reconstruction was carried out using autologous bone in all cases except for 1. Esthetic morphological satisfaction was obtained in all 11 cases. In 2 of 6 cases with optic canal decompression, 1 exhibited half-blindness, and the other exhibited quarter-blindness postoperatively. In 5 cases without decompression, there have been no changes in visual acuity through follow-up ranging from 5 to 22 years. Although therapeutic decompression is well accepted, prophylactic decompression is controversial and the efficacy of prophylactic decompression is questionable. Current strategies should focus on esthetic improvement, with careful observation carried out to assess for optic canal encroachment without prophylactic decompression.