Bilateral endonasal endoscopic optic nerve decompression in a 7-month-old male patient with osteopetrosis: A case report with review of the literature

• Infantile osteopetrosis can present with early, rapid visual decline due to bilateral optic canal stenosis. • Early ophthalmologic evaluation should be considered in patients with infantile osteopetrosis to evaluate for optic nerve compression. • Endoscopic endonasal optic nerve decompression is a feasible minimally invasive option even in the absence of sphenoid pneumatization. • Early optic nerve decompression may improve visual tracking and optic disc appearance despite advanced disease. Congenital narrowing of the optic canal leading to compression of the optic nerve is a rare disorder that has its own diagnostic and treatment challenges. When it comes to treatment modalities, a few surgical techniques have been described to decompress the optic canals, mainly the supraorbital and endonasal endoscopic approaches. While the supraorbital technique will be discussed briefly, our focus will be on the endoscopic endonasal optic nerve decompression (EOND) approach. Although this technique has been described for nerve decompression in adolescents and adults, it has rarely been reported for young children with non-traumatic narrowing and absence of pneumatized sphenoid sinuses in only three recent case reports, two of which were those of osteopetrosis, as is the case in our patient. This case report aims to present the case of bilateral EOND for a 7-month-old male with osteopetrosis with a review of the literature on the available cases and the current diagnostic and surgical approaches in such cases in children. We consider the importance of investigating patients with suspected osteopetrosis for cranial neuropathies, specifically compression of the optic nerve. In addition, our case also highlights the role of EOND as a viable minimally invasive decompression technique when performed in appropriately equipped centers by experienced surgeons.