Compressive optic neuropathy caused by a nonectatic internal carotid artery: illustrative case

BACKGROUND Optic nerve compression from direct contact with the internal carotid artery (ICA) is a rarely described cause of monocular vision loss. Thus, little is known about the incidence, optimal management, and outcomes of this particular type of compressive optic neuropathy. OBSERVATIONS The authors present the case of a 52-year-old female with progressive monocular vision loss. After an extensive workup, including a formal neuro-ophthalmology assessment, her symptoms were attributed to a neurovascular conflict between the optic nerve and a nonectatic supraclinoid ICA. She underwent a pterional craniotomy for optic nerve decompression, including bony unroofing of the optic canal and fenestration of the dural sheath. On follow-up, there was improvement in both her radiographic and clinical findings. LESSONS This case highlights a unique indication for optic nerve decompression in the setting of monocular vision loss caused by nonectatic vascular compression. https://thejns.org/doi/10.3171/CASE24623