亲爱的研友该休息了!由于当前在线用户较少,发布求助请尽量完整地填写文献信息,科研通机器人24小时在线,伴您度过漫漫科研夜!身体可是革命的本钱,早点休息,好梦!

Fibrous Dysplasia: Management of the Optic Canal

视神经管 医学 纤维发育不良 视神经 减压 发育不良 外科 视神经病变 眼科 病理
作者
Andrea B. Burke,Alison M. Boyce,Michael T. Collins
出处
期刊:Plastic and Reconstructive Surgery [Lippincott Williams & Wilkins]
卷期号:137 (6): 1060e-1061e 被引量:3
标识
DOI:10.1097/prs.0000000000002210
摘要

Sir: In Dr. Satterwhite and colleagues’ article, “Fibrous Dysplasia: Management of the Optic Canal,”1 the authors reported their experience with prophylactic optic nerve decompression. Long-term visual compromise developed in two of five fibrous dysplasia patients undergoing therapeutic optic nerve decompression and one of seven patients undergoing prophylactic optic nerve decompression, with three of 12 (25 percent) having adverse outcomes. They concluded that fibrous dysplasia patients who underwent prophylactic optic nerve decompression had better outcomes, and that optic nerve unroofing is “safe in our [sic] hands.” We disagree with the authors’ belief that, “optic canal involvement is a predictor for impending optic nerve damage.” Our National Institutes of Health cohort2 reported 13 patients with optic neuropathy, of which 10 had growth hormone excess [seven of 13 (54 percent)] or associated aneurysmal bone cyst [three of 13 (23 percent)]. We know growth hormone excess in fibrous dysplasia is associated with macrocephaly and vision loss, with some patients developing blindness. Recent analysis of the National Institutes of Health cohort indicates that early diagnosis and treatment may prevent growth hormone excess–associated morbidity (specifically, vision loss).3 Furthermore, optic nerve decompression in symptomatic patients has been shown to have high perioperative morbidity. We advocate for close observation (i.e., frequent ophthalmologic examinations with optical coherence tomography and evoked potentials, and medical treatment of growth hormone excess when present) as the preferred approach to patients with fibrous dysplasia encasement of the optic canal. Thus, we feel that confounding factors such as untreated growth hormone excess and aneurysmal bone cysts, not long-term involvement of the optic canal, are predictors of visual compromise in the McCune-Albright population. This case series did not state whether patients had growth hormone excess or associated aneurysmal bone cyst. We stress the importance of a complete workup in fibrous dysplasia patients before surgery, because growth hormone excess can be treated nonoperatively, reducing the risk of optic neuropathy. Amit et al. performed a meta-analysis4 on patients from the National Institutes of Health: a total of 368 nerves were included in the meta-analysis; long-term follow-up revealed that surgery in asymptomatic patients is associated with worse prognosis compared with patients managed expectantly. Moreover, growth hormone excess was not found to have an association with optic neuropathy because young subjects with reported excess underwent early treatment. Visual loss was seen only in subjects whose growth hormone excess diagnosis and treatment were delayed until adulthood, as none of the subjects treated in childhood had visual disturbances.5 There is no evidence that fibrous dysplasia progression can be predicted, and it is not possible to foresee which patients would benefit from optic nerve decompression surgery. We agree that a randomized, prospective trial would be informative though difficult. Although the authors report a lower risk in prophylactic decompression at their center, they admit that, “Other authors have reported blindness with prophylactic unroofing, but in our hands, this never happened.” In light of the meta-analysis performed, it is unreasonable to create a standard of care based on the abilities of a few surgeons who have had rare complications. Furthermore, an outcome of three of 12 patients (25 percent) developing visual compromise is still relatively high. We strongly recommend against prophylactic optic nerve decompression based on the aforementioned meta-analysis data and our experience from the natural history protocol ongoing at the National Institutes of Health. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. ACKNOWLEDGMENT This research was supported by the Intramural Research Program of the National Institutes of Dental and Craniofacial Research, National Institutes of Health. © copyright property of Intramural Research Program of the National Institutes of Dental and Craniofacial Research, National Institutes of Health. Andrea B. Burke, D.M.D., M.D.Alison M. Boyce, M.D.Michael T. Collins, M.D.Skeletal Clinical Studies SectionCraniofacial and Skeletal Diseases BranchNational Institutes of Dental and Craniofacial ResearchNational Institutes of HealthBethesda, Md.

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
2秒前
27秒前
jennie完成签到 ,获得积分10
29秒前
29秒前
艾米发布了新的文献求助10
33秒前
47秒前
sycsyc完成签到,获得积分10
52秒前
轻松的惜芹应助艾米采纳,获得10
52秒前
轻松的惜芹应助艾米采纳,获得10
52秒前
52秒前
53秒前
科研通AI2S应助科研通管家采纳,获得10
1分钟前
科研通AI2S应助科研通管家采纳,获得10
1分钟前
量子星尘发布了新的文献求助10
1分钟前
1分钟前
1分钟前
guoze完成签到,获得积分10
1分钟前
1分钟前
田様应助执着的草丛采纳,获得10
1分钟前
2分钟前
量子星尘发布了新的文献求助10
2分钟前
2分钟前
哈尔滨发布了新的文献求助10
2分钟前
2分钟前
2分钟前
伯赏元彤发布了新的文献求助10
2分钟前
2分钟前
科研通AI2S应助科研通管家采纳,获得10
3分钟前
CodeCraft应助科研通管家采纳,获得10
3分钟前
3分钟前
3分钟前
3分钟前
我是老大应助执着的草丛采纳,获得10
3分钟前
3分钟前
3分钟前
3分钟前
量子星尘发布了新的文献求助10
4分钟前
4分钟前
科研通AI2S应助科研通管家采纳,获得10
5分钟前
科研通AI2S应助科研通管家采纳,获得10
5分钟前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 700
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3976665
求助须知:如何正确求助?哪些是违规求助? 3520756
关于积分的说明 11204771
捐赠科研通 3257528
什么是DOI,文献DOI怎么找? 1798733
邀请新用户注册赠送积分活动 877897
科研通“疑难数据库(出版商)”最低求助积分说明 806629