Evaluation of Optic Nerve Sheath Fenestration in Pseudotumor Cerebri Using Automated Perimetry

Pseudotumor Cerebri (Idiopathic Intracranial Hypertension) an Update

“…Surgery should be carried out as soon as a visual field defect worsens or remains unimproved despite maximal treatment. Medical treatment fails in approximately 18% to 22% of patients with PTC (Burgett et al, 1997;Corbett & Thompson, 1989;Lorberboym et al, 2001;Lueck & McIlwaine, 2002;Pearson et al, 1991). According to Friedman et al (2004), ophthalmological indications for surgical intervention are severe or rapid visual loss at onset ("malignant IIH"), severe papilledema causing macular edema or exudates without improvement while undergoing medical treatment.…”

Descompressão da bainha do nervo óptico para tratamento do papiledema no pseudotumor cerebral

“…Quando existe progressão da perda visual, a despeito destas medidas terapêuticas o tratamento cirúrgico pode ser realizado através de derivação lombo-peritoneal ou de descompressão da bainha do nervo óptico (DBNO). Nos últimos anos, a DBNO tem sido considerada, por muitos autores, o tratamento de escolha do PTC nos casos de perda visual não responsiva ao tratamento clínico (5)(6)(7)(8)(9)(10)(11) . O objetivo deste trabalho é relatar nossa experiência com 17 pacientes (24 olhos operados) portadores de PTC e perda visual, e avaliar a eficá-cia deste procedimento.…”

Untitled

“…16 Surgical management is reserved for refractory patients. 17,18 A cerebrospinal fluid shunting can be performed to relieve intracranial pressure. 17 Less frequently, fenestration of the optic nerve may be indicated to preserve visual function.…”

“…17 Less frequently, fenestration of the optic nerve may be indicated to preserve visual function. 18 Based on recent physiopathological concepts, stenting in the dural sinus has been recommended in selected cases after detection of pressure variation caused by sinus stenosis. The extent to which intracranial pressure elevation is the cause or consequence of venous sinus stenosis is unclear, but the procedure has gained increasing popularity.…”