A literature search was conducted in April 2024 across Ovid MEDLINE, PubMed, Embase, Scopus, and Web of Science, following PRISMA guidelines. Inclusion criteria were studies and case reports of patients with primary optic nerve tumors who underwent microsurgical or endoscopic resection. Excluded were nonhuman studies, those lacking treatment or outcome data, and tumors that were not primary optic nerve lesions. 

A total of 16 sudies comprising 100 patients with primary optic nerve tumors were included. Pathologies included optic pathway glioma (n=6), optic nerve sheath meningioma (n=5), and rare lesions such as schwannoma, ganglioglioma, lymphoma, and medulloepithelioma. Gross-total resection (GTR) was achieved in 60% of endoscopic cases versus 40% of microsurgical cases, predominantly for isolated intraorbital or canalicular tumors. Visual outcomes favored endoscopic decompression and nerve-sparing techniques, with 70–90% of patients maintaining or improving vision postoperatively. In contrast, microsurgical approaches often led to visual decline, especially when aggressive resections were attempted. Endoscopic surgery demonstrated lower rates of cranial nerve and cosmetic complications, though it carried risks of CSF leak (10%) and transient endocrinopathy. Recurrence correlated primarily with subtotal resection and aggressive histology rather than surgical approach. 

Endoscopic surgery offers a safe, minimally invasive alternative to traditional microsurgical techniques for select optic nerve tumors, offering comparable tumor control with superior visual and cosmetic outcomes. Microsurgery remains indicated for extensive or lateral lesions beyond endoscopic reach. High-quality longitudinal studies are needed to clarify the long-term clinical outcomes for both techniques.