Fibrous Dysplasia of the Sphenoid and Skull Base

This article reviews the current literature and level-1 evidence of the natural history and the medical and surgical treatment of skull base fibrous dysplasia. The high rate of optic nerve (ON) involvement and the potential risk of visual impairment as a result of nerve compression have led many surgeons to suggest prophylactic decompression of the ON in asymptomatic patients. However, review of the cases reported in the literature reveals that ON decompression surgery is indicated only for patients with visual deficits, whereas asymptomatic patients with radiologic evidence of ON compression are better managed conservatively.