Optic nerve sheath decompression saves sight in severe papilloedema: results from 81 eyes in 56 patients with pseudotumor cerebri

Bajin, Meltem Söylev; Engin, Ceren Durmaz; Yaman, Aylın; Ayhan, Zi̇ya; Gökçay, Figen; Çelebisoy, Neşe; Men, Süleyman; Akdal, Gülden; Hálmagyi, G. Michael

doi:10.1111/aos.14732

Cited by 3 publications

(5 citation statements)

References 36 publications

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“…Our results confirm these reports and show again that ONSF can improve visual function and substantially restore both VF and VA, even in fulminant PTC with severe acute visual impairment. The results are worse in cases presenting with chronic neglected papilloedema and evidence of optic atrophy 6 ; in 6 of our patients neither VF nor VA improved much, or even continued to deteriorate 50 despite bilateral ONSF, as well as TSS, so that all 6 ended up functionally blind.…”

Section: Discussionmentioning

confidence: 51%

“…Even unilateral ONSF can improve papilloedema in both eyes 6,[47][48][49] and in these cases MD can be an accurate marker for resolution of disc swelling. 48 Our results confirm these reports and show again that ONSF can improve visual function and substantially restore both VF and VA, even in fulminant PTC with severe acute visual impairment.…”

Section: Discussionmentioning

confidence: 97%

“…In patients with severe or fulminant PTC a case can be made for operating first on either the better-seeing or the worse-seeing eye. 49 We decided to operate first on the worse seeing eye, as this might improve vision not just in the operated eye but also in the fellow eye 6,[47][48][49] ; this is what happened in 9 of our 17 unilateral ONSF patients. ONSF must precede TSS as patients need dual agent antiplatelet therapy for at least 1 week before stenting and for 3 months afterwards and then aspirin alone for 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…3 Since then, reports from all over the world have confirmed that ONSF can, with acceptable risk, relieve papilloedema and improve, or at least salvage vision, even in eyes with severe vision loss. [4][5][6] Pseudotumour cerebri (PTC) is the syndrome of intracranial hypertension without intracranial mass or hydrocephalus. 7,8 In most cases there is stenosis of the dominant transverse sinus or of both sinuses and this can be both the cause and the effect of the intracranial hypertension.…”

Section: Introductionmentioning

confidence: 99%

“…Optic nerve sheath fenestration (ONSF), of sorts, was first tried for the treatment of papilloedema in the late 19th century, first in Paris by de Wecker – the leading French ophthalmologist of his day, 1 later in London by Carter 2 and then modernised in Melbourne by Galbraith and Sullivan 3 . Since then, reports from all over the world have confirmed that ONSF can, with acceptable risk, relieve papilloedema and improve, or at least salvage vision, even in eyes with severe vision loss 4–6 …”

Section: Introductionmentioning

confidence: 99%

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Optic nerve sheath fenestration for treating papilloedema in the era of cerebral venous sinus stenting

McCluskey

Lam

Ang

et al. 2023

Clinical Exper Ophthalmology

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Background Pseudotumour cerebri (PTC) is the syndrome of intracranial hypertension without intracranial mass or hydrocephalus and is the commonest cause of papilloedema seen in many eye clinics. In the last 10 years, we have increasingly used TSS in patients whose papilloedema was not well controlled with medical treatment and have done fewer ONSFs. Here, we review our experience at Royal Prince Alfred Hospital Sydney with ONSF in 35 patients over the period 2002–2021. Methods Retrospective case series of 35 patients, 30 of whom had primary PTC [i.e., idiopathic intracranial hypertension (IIH)] and 5 with secondary PTC. Results Eighteen patients had bilateral ONSF and 17 patients unilateral ONSF, in each case of the worse eye. Thirteen patients then underwent transverse sinus stenting (TSS), in each case following ONSF. The primary outcome measures were visual acuity (VA) and mean deviation (MD) on visual field (VF) testing. MD improved by 5 dB or more in 34 of 70 total eyes (48.6%); VA improved by 0.2 logMAR (two lines on Snellen chart) or more in 21 eyes (30%), and by both in 15 eyes (21.4%). Final MD was −10 dB or better in 38 eyes (54.3%); final VA was 0.3 (6/12) or better in 54 eyes (77.1%), and both in 39 eyes (55.7%). Conclusions The results confirm that ONSF can relieve papilloedoema in both eyes and improve both VF and VA, even in cases of fulminant PTC with severe acute visual impairment.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Optic nerve sheath fenestration for treating papilloedema in the era of cerebral venous sinus stenting

McCluskey

Lam

Ang

et al. 2023

Clinical Exper Ophthalmology

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Effectiveness of optic nerve sheath fenestration in preserving vision in idiopathic intracranial hypertension: an updated meta-analysis and systematic review

Prokop,

Opęchowska,

Sieśkiewicz

et al. 2024

Acta Neurochir

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Background This study aims to evaluate the effectiveness of Optic Nerve Sheath Fenestration (ONSF) in improving visual outcomes in patients with Idiopathic Intracranial Hypertension (IIH). Methods A meta-analysis was conducted using data from 19 studies, totaling 1159 observations. The main assessed outcomes after ONSF surgery were: the improvement in visual acuity, the improvement in visual fields and reduction in papilledema. We performed separate analyses to distinguish between outcomes using different surgical approaches. Comprehensive literature searches were conducted in the Ovid MEDLINE(R) and SCOPUS databases, following PRISMA guidelines. Statistical analyses employed a Generalized Linear Mixed Model (GLMM) to integrate proportion data, with heterogeneity assessed via I-squared and H statistics. Publication bias was evaluated using funnel plots, Egger's test, and Peters' test. Results The analysis revealed that ONSF significantly improved visual acuity in 41.09% of patients, and visual fields in 76.34% of cases. The transconjunctival approach demonstrated higher success rates for visual field improvement. A high improvement rate of 97% was observed in reducing optic disc swelling. Significant heterogeneity was noted, particularly in visual acuity (I2 = 92.1%) and visual field improvements (I2 = 73.8%), reflecting variability in surgical techniques and patient demographics. Publication bias assessments indicated no significant bias for visual acuity and visual field outcomes, although potential bias was detected for papilledema reduction. Conclusions This meta-analysis confirms that ONSF is effective in improving visual outcomes for IIH patients, especially when using the transconjunctival approach. Early surgical intervention is crucial for optimal results, principally in preventing advanced ischemic damage. Despite high success rates, observed heterogeneity highlights the need for standardized surgical techniques and further investigation into patient-specific factors influencing outcomes. Addressing potential publication bias and conducting more rigorous studies will enhance the reliability of future meta-analyses. Upcoming research in ONSF efficacy is needed to refine surgical practices and optimize patient care.

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Optic nerve sheath fenestration for visual impairment in cerebral venous diseases

et al. 2023

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ObjectiveVisual impairment is the most common clinical feature of cerebral venous sinus occlusion or cerebral venous thrombosis-induced intracranial hypertension, which can result in optic atrophy, leading to irreversible vision loss, visual field defections, and finally, permanent blindness. Papilledema is a typical early pathophysiological alteration in visual impairment. Optic nerve sheath fenestration (ONSF) has become increasingly accepted as an option to prevent or halt progressive visual loss owing to its low risk and complications. The objective of this study is to review the latest research progress on ONSF for the treatment of visual impairment related to cerebral venous diseases.MethodsStudy were searched following PRISMA guidelines based on three electronic databases (Pubmed, Embase and Medline-Ovid). We used the following keywords and variations as keywords to identify studies: “optic nerve sheath fenestration, papilledema, cerebral venous diseases, cerebral venous stenosis, cerebral venous thrombosis, idiopathic intracranial hypertension”. The publication date of studies was restricted between 1,872.1.1 and 2,021.12.31. The application of ONSF in papilledema due to cerebral venous diseases is reviewed. Additionally, the common surgical approaches as well as advantages and disadvantages are also described graphically.ResultsWith the improvement of specific details of the ONSF procedure and surgical instruments, complications of ONSF have reduced and its safety has been significantly improved, although the number of clinically investigated cases in the literature remains low.ConclusionWe recommend that ONSF should be considered as an imperative alternative to reduce or delay the visual morbidity of cerebral venous diseases, although there is yet no consensus on the optimal surgical timing.

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Optic nerve sheath decompression saves sight in severe papilloedema: results from 81 eyes in 56 patients with pseudotumor cerebri

Cited by 3 publications

References 36 publications

Optic nerve sheath fenestration for treating papilloedema in the era of cerebral venous sinus stenting

Optic nerve sheath fenestration for treating papilloedema in the era of cerebral venous sinus stenting

Effectiveness of optic nerve sheath fenestration in preserving vision in idiopathic intracranial hypertension: an updated meta-analysis and systematic review

Optic nerve sheath fenestration for visual impairment in cerebral venous diseases

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