Protocol to optimize vision preservation after tumor resection involving the optic apparatus

Postoperative visual decline after skull base tumor resection remains a serious and often irreversible complication. Herein, we investigated a structured Optic Nerve Protocol (ONP) designed to minimize ischemic injury and enhance visual recovery following skull base surgery. A retrospective review was performed at a single tertiary center on patients undergoing tumor resection involving the optic apparatus. Patients were stratified into two groups: (i) underwent the ONP, which includes high-dose corticosteroids, mean arterial pressure (MAP) augmentation (> 90 mmHg), euvolemia or mild hypervolemia, and structured visual monitoring, (ii) did not. To assess delayed visual outcomes, the primary analysis included patients whose vision was unchanged between preoperative and immediate postoperative evaluations. Additionally, we reviewed patients who developed new postoperative visual deficits and responded to ONP with visual improvement. Among 37 patients reviewed, 17 received ONP and 20 did not. Of those with stable immediate postoperative vision (9 ONP; 11 non-ONP), visual improvement at follow-up was significantly more frequent in the ONP group ( p = 0.0498). Patients receiving ONP were administered higher cumulative corticosteroid doses ( p = 0.0330), whereas MAP augmentation did not differ significantly. In a subset of patients with newly acquired postoperative visual decline, two experienced a recovery following prompt ONP initiation. The protocol was safely implemented using standard intensive care resources without added procedural risk. The ONP may facilitate delayed visual recovery and reversal of acute postoperative deficits after skull base tumor resection. Its safety, feasibility, and neuroprotective framework warrant validation in prospective multi-center studies to optimize visual outcomes.