Abstract
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.