Modified endoscopic optic nerve decompression in idiopathic intracranial hypertension

Gupta, Ashok; Ganth, M. G. Rajini; Gupta, Amod

doi:10.1258/002221503321892406

Cited by 17 publications

(13 citation statements)

References 8 publications

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“…While decompression in traumatic optic neuropathy has been widely investigated, 11,13,[18][19][20]24,28,29,36,37,40,47,48,[52][53][54][55][56][57][58][59]61 indeed with debatable results, decompression for nontraumatic optic neuropathies (NONs) is still insufficiently studied. 2,3,5,12,15,17,[21][22][23][25][26][27]33,35,36,39,41,42,45,46,51 We hypothesize that the minimally invasive endoscopic endonasal approach will be more widely used in decompressions for nontraumatic pathologies of the orbital apex. We present our preliminary series of 11 optic nerve decompressions performed for NONs.…”

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confidence: 99%

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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Object While several approaches have been described for optic nerve decompression, the endoscopic endonasal route is gaining favor because it provides excellent exposure of the optic canal and the orbital apex in a minimally invasive manner. Very few studies have detailed the experience with nontraumatic optic nerve decompressions, whereas traumatic cases have been widely documented. Herein, the authors describe their preliminary experience with endoscopic endonasal decompression for nontraumatic optic neuropathies (NONs) to determine the procedure’s efficacy and delineate its potential indications and limits. Methods The medical reports of patients who had undergone endoscopic endonasal optic nerve and orbital apex decompression for NONs at the Lyon University Neurosurgical Hospital in the period from January 2012 to March 2014 were reviewed. For all cases, clinical and imaging data on the underlying pathology and the patient, including demographics, preoperative and 6-month postoperative ophthalmological assessment results, symptom duration, operative details with video debriefing, as well as the immediate and delayed postoperative course, were collected from the medical records. Results Eleven patients underwent endoscopic endonasal decompression for NON in the multidisciplinary skull base surgery unit of the Lyon University Neurosurgical Hospital during the 27-month study period. The mean patient age was 53.4 years, and there was a clear female predominance (8 females and 3 males). Among the underlying pathologies were 4 sphenoorbital meningiomas (36%), 3 optic nerve meningiomas (27%), and 1 each of trigeminal neuroma (9%), orbital apex meningioma (9%), ossifying fibroma (9%), and inflammatory pseudotumor of the orbit (9%). Fifty-four percent of the patients had improved visual acuity at the 6-month follow-up. Only 1 patient whose sphenoorbital meningioma had been treated at the optic nerve atrophy stage continued to worsen despite surgical decompression. The 2 patients presenting with preoperative papilledema totally recovered. One case of postoperative epistaxis was successfully treated using balloon inflation, and 1 case of air swelling of the orbit spontaneously resolved. Conclusions Endoscopic endonasal optic nerve decompression is a safe, effective, and minimally invasive technique affording the restoration of visual function in patients with nontraumatic compressive processes of the orbital apex and optic nerve. The timing of decompression remains crucial, and patients should undergo such a procedure early in the disease course before optic atrophy.

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confidence: 99%

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Berhouma

Jacquesson

Abouaf³

et al. 2014

FOC

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“…Although some patients underwent ONSF with the endoscopic endonasal method (71,72), there are also patients who received optic decompression without ONSF (73,74). Endoscopic endonasal procedures may be unilateral (71,73,74) or bilateral (72). Endoscopic unilateral optic decompression is a newly defined method with low complication rates, and has positive effects on headache, papilledema, and visual field (73).…”

Section: Treatmentmentioning

confidence: 99%

Idiopathic Intracranial Hypertension: Diagnosis and Therapeutic Approach

Akçakaya¹,

Akçakaya²,

Sencer³

et al. 2017

tnd

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Ad dress for Cor res pon den ce/Ya z›fl maIdiopathic intracranial hypertension (IIH) is a condition of increased intracranial pressure without a secondary etiology. IIH is seen frequently in young and obese women. Headache, vision problems, and pulsatile tinnitus are the most common symptoms that lead patients to physicians. IIH requires a multidisciplinary approach because it could create permanent morbidity and its treatment plan should be individualized for each patient. The aim of this review was to provide an updated overview of IIH's pathogenesis, diagnostic criteria, and treatment strategies.Keywords: Idiopathic intracranial hypertension, pseudotumor cerebri, primary pseudotumor cerebri, optic nerve compartment syndrome, review İdiyopatik intrakraniyal hipertansiyon (İİH) sekonder bir nedene bağlı olmayan kafa içi basınç artışıdır. Sıklıkla genç ve obez kadınlarda görülür. Baş ağrısı, görme problemleri ve pulsatil kulak çınlaması hastaları en çok hekime götüren şikayetlerdir. İİH heterojen bulgu ve belirtileri nedeniyle aile hekimlerini ve birçok branşı birlikte ilgilendirmektedir. Tedavisi gecikirse kalıcı morbidite yaratan bu hastalıkta her olgu için kişiye özgü bir tedavi planlanmalıdır. Bu yazıda son yayınlar çerçevesinde İİH'nin etiyopatogenezi ile birlikte tanı ve tedavisi gözden geçirilmiştir.Anahtar Kelimeler: İdiyopatik intrakraniyal hipertansiyon, psödotümör serebri, primer psödotümör serebri, optik sinir kompartman sendromu, derleme Abstract Öz

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“…11 Surgical modalities vary from minimally invasive endoscopic optic nerve sheath fenestration (ONSF) to shunting procedures to medial or lateral orbitotomy and transconjunctival optic nerve sheath decompression to subtemporal craniotomy. [12][13][14][15][16][17] …”

Section: Introductionmentioning

confidence: 99%

Pediatric Idiopathic Intracranial Hypertension: A not so Rare and Benign Condition

Modi¹,

Gupta²

2014

An International Journal Clinical Rhinology

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Objective: Pediatric idiopathic intracranial hypertension is an underdiagnosed entity with catastrophic presentations. High index of suspicion with early diagnosis and prompt treatment is the key to successful management. Trans-nasal trans-sphenoid Endoscopic Optic Nerve Fenestration is an effective surgical modality for the reversal of vision loss in pediatric idiopathic intracranial hypertension (IIH). Materials and methods:This is a single center observational prospective case series. Five diagnosed pediatric patients of IIH satisfying the modifi ed Dandy criteria and reported to the out-patient services of otolaryngology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India in the year 2012 were included in this study. All children underwent thorough clinical examination, complete Neuroophthalmological work-up including Visual acuity (V/A), Visual field charting (V/F), Fundus venogram and Radiological work-up with MRI for special optic nerve sections in sagittal reconstruction. Cerebro-Spinal Fluid pressure (CSF) measured preoperatively for all children. Standard endoscopic optic nerve Sheath Fenestration was performed on all children. visual improvement was assessed by comparing preoperative ophthalmological fi ndings.Results: Improvement in vision was taken as a positive outcome. Vision improved in all except one child, who had preexisting optic nerve atrophy.Conclusion: Endoscopic optic nerve fenestration is an effective minimally invasive procedure to revert visual loss in pediatric idiopathic intracranial hypertension.

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Modified endoscopic optic nerve decompression in idiopathic intracranial hypertension

Abstract: A case of idiopathic intracranial hypertension (IIH) with visual field loss was decompressed in the intracanalicular segment of the optic nerve transnasally under endoscopic control. Visual functions improved after surgery.

Cited by 17 publications

References 8 publications

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

Idiopathic Intracranial Hypertension: Diagnosis and Therapeutic Approach

Pediatric Idiopathic Intracranial Hypertension: A not so Rare and Benign Condition

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