Modified Optic Nerve Decompression in Patients with Functioning Lumboperitoneal Shunts and Progressive Visual Loss

Endoscopic implantation and patency evaluation of lumboperitoneal shunt: an innovative technique

“…Although vision became stable in one patient, none of the patients had progressive visual deterioration after LP shunt implantation. However, Kelman et al [6] reported on 12 patients who continued to lose vision despite receiving LP shunts; this poor outcome serves to underscore the good control of IIH that we achieved by using laparoscopy in the present series.…”

An update on the management of pseudotumor cerebri

“…Furthermore, a technique for endoscopic ONSF via the trans-nasal route with no external incisions has been described, making this procedure the most cosmetically benign pseudotumor surgery. ONSF has also been shown to preserve vision in cases where vision deteriorates despite a functioning shunt [65,68,69].…”

Having the vision to measure calcium

“…In the present case, as in a case previously reported by our group [5], raised intracranial pressure was not a feature. There is, however, a view that differences in CSF pressure may exist within different compartments of the subarachnoid space, with elevated local CSF pressure at the optic nerve head possibly causing ischaemic neuronal loss and papilloedema [6][7][8][9]. This may explain not only the differential effect in each eye, leading to a pseudo-Foster Kennedy syndrome (unilateral optic atrophy and contralateral papilloedema with no intracranial mass), but also the normal CSF opening pressure.…”