ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neuro-Ophthalmology
The Role of Endoscopic versus Microsurgical Techniques in Optic Canal Decompression: A Meta-Analysis of Randomized Controlled Trials
Provisionally accepted
Feng Lin*
Peng Song- Guangyuan Central Hospital, Guangyuan, China
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Background: The ideal surgical technique for optic canal decompression (OCD) in instances of compressive optic neuropathy continues to be the subject of contention. Endoscopic and microsurgical OCD procedures have demonstrated encouraging outcomes; however, their comparative efficacy in enhancing visual acuity and post-op complications remains unclear. This meta-analysis thus evaluated the safety and efficacy of these methods across different circumstances. Methods: A systematic review and meta-analysis were performed in accordance with PRISMA recommendations. Relevant randomized controlled trials (RCTs) were located via PubMed, Embase, Cochrane Library, Scopus and Web of Science. Studies assessed endoscopic and microsurgical decompression techniques for compressive ocular neuropathies. Statistical analyses were conducted utilizing RevMan 5.4. A fixed-effects model was utilized owing to minimal heterogeneity (I² = 0%), with statistical significance set at p < 0.05. Results: A total of seven studies (n = 194 participants) were incorporated. Endoscopic techniques demonstrated considerable enhancements in visual acuity, especially for medial canal disorders (RR = 2.01; p < 0.00001). Microsurgical techniques gave superior circumferential decompression, up to 252.8° with pterional craniotomy, in contrast to 124.6° attained with endoscopic methods. Both procedures demonstrated minimal complication rates, with no substantial variations in postoperative cerebrospinal fluid (CSF) leakage or necessity for reoperation. Funnel plots suggested negligible publication bias and sensitivity analysis validated the strength of findings. Conclusion: Both endoscopic and microsurgical techniques were effective for OCD, with endoscopic methods providing least invasive advantages and microsurgical approaches excelling in complex diseases necessitating considerable decompression.
Keywords: Compressive optic neuropathy, Endoscopic decompression, Microsurgical decompression, Optic canal surgery, visual acuity improvement
Received: 22 Aug 2025; Accepted: 31 Oct 2025.
Copyright: © 2025 Lin and Song. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Feng Lin, lin13060167261@outlook.com
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