Optic Nerve Sheath Fenestration for Pseudotumor Cerebri

Goh, Kong Yong; Schatz, Norman J.; Glaser, Joel S.

doi:10.1097/00041327-199706000-00003

Cited by 72 publications

(41 citation statements)

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“…1,3,7,8,16,37,39 In all, 423 eyes of 252 patients were evaluated with a mean follow-up of 21.1 months (range 0-121 months). The patients' mean age was 33.6 years (range 6-72 years), and 83% of the patients were female.…”

Section: Optic Nerve Sheath Decompressionmentioning

confidence: 99%

Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension

Feldon¹

2007

Neurosurgical FOCUS

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Object. The object of this study was to compare surgical techniques for management of visual loss in idiopathic intracranial hypertension (IIH) unresponsive to medical treatment.Methods. The published literature was reviewed using electronic and manual search techniques. Articles were categorized based upon the surgical procedure performed, including optic nerve sheath decompression (ONSD), also called optic nerve sheath fenestration; intracranial venous sinus stent placement; ventriculoperitoneal (VP) shunt placement; and lumboperitoneal (LP) shunt placement. Demographic data and visual outcome of the cumulative experience were compiled and compared for each type of surgical intervention.Results. Seventeen patients treated by stent placement, 31 by VP shunt placement, 44 by LP shunt placement, and 252 patients by ONSD were identified in the literature; average follow-up ranged from 11.8 months for patients treated with stents to 57.2 months for those treated with LP shunts. Improved or resolved vision deficit was noted in 38.7% of patients after VP shunt placement, 47% of patients after stent placement, 44.6% of patients after LP shunt placement, and 80% of eyes after ONSD. Visual worsening was rare for all procedures evaluated.Conclusions. There is a paucity of information regarding visual outcomes from intracranial venous stent placement and cerebrospinal fluid diversion procedures. Visual outcomes from ONSD are better documented and appear to be superior to other surgical techniques for management of IIH. Further studies with improved data collection regarding visual outcomes are needed for surgical procedures other than ONSD in order to assess their possible value as treatments for visual loss in IIH.

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Section: Optic Nerve Sheath Decompressionmentioning

confidence: 99%

Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension

Feldon¹

2007

Neurosurgical FOCUS

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“…Nossos resultados confirmam o de outros autores (5)(6)(7)(15)(16)(17) que enfatizaram a eficácia da DBNO no tratamento do papiledema com perda visual. Corbett et al (7) obtiveram controle do papiledema e melhora visual em 34 de 40 olhos operados; Sergott et al (6) obtiveram melhora da visão em 21 de 23 pacientes operados e Bourman et al (5) em todos os seis pacientes com PTC submetidos à DBNO.…”

Section: Discussionunclassified

“…Todos os olhos que tinham perda visual por papiledema agudo melhoraram, enquanto que apenas 10 dos 39 que tinham papiledema crônico obtiveram melhora. Mais recentemente Goh et al (16) obtiveram melhora visual em 93% e Banta e Farris (17) em 94% dos olhos de pacientes com PTC submetidos a este procedimento cirúrgico.…”

Section: Discussionunclassified

“…O procedimento cirúrgi-co nesta paciente, no entanto, parece ter auxiliado no controle do olho contralateral, que após a cirurgia apresentou resolução do papiledema e estabilização da visão. Deve ser salientado que nossa casuística inclui um número muito grande de pacientes operados em fase final da doença, o que explica a baixa porcentagem de melhora visual, quando comparada a de outros autores (16)(17) . Muitos deles foram submetidos à cirurgia numa tentativa desesperada de recuperação visual.…”

Section: Discussionunclassified

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

Monteiro¹

2002

Arq. Bras. Oftalmol.

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“…Optic nerve sheath fenestrations are effective at relieving papilledema and progressive visual loss in most cases. 4,9,17,25 In contrast to CSF diversionary procedures, however, optic nerve sheath fenestrations are ineffective at relieving headaches. Reported complications of optic nerve sheath fenestrations include peripapillary hemorrhage, new visual field deficits, blindness, cranial nerve paresis, and stroke.…”

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confidence: 99%

Refractory idiopathic intracranial hypertension treated with stereotactically planned ventriculoperitoneal shunt placement

Maher

Garrity

Meyer³

2001

FOC

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Object Ventriculoperitoneal (VP) shunts have not been widely used for idiopathic intracranial hypertension (IIH) because of the difficulty of placing a shunt into normal or small-sized ventricles. The authors report their experience with stereotactic placement of VP shunts for IIH. Methods The authors reviewed the clinical records of all patients in whom stereotaxis was used to guide the placement of a VP shunt for IIH at their institution. All shunts were placed using stereotactic guidance to target the frontal horn of the lateral ventricle. Patients were contacted at a mean postoperative interval of 15.1 months. No patients were lost to follow up. The authors identified 13 patients who underwent placement of a stereotactically guided VP shunt for IIH over a 6-year period. A trial of either acetazolamide or steroid therapy had failed in all patients. Prior surgical treatments included optic nerve sheath fenestrations in seven patients and cerebrospinal fluid diversionary procedures, other than stereotactic VP shunt procedures, in nine patients. Twelve patients reported excellent or good durable symptomatic relief at the time of follow up. No patient suffered progression of visual deficits. Four patients experienced persistent headaches following the procedure. Three patients required a revision of the VP shunt for technical failure. Conclusions Stereotactically guided VP shunt placement is an effective and durable treatment option in many cases of IIH that are refractory to more traditional medical and surgical approaches.

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Optic Nerve Sheath Fenestration for Pseudotumor Cerebri

Cited by 72 publications

References 0 publications

Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension

Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension

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

Refractory idiopathic intracranial hypertension treated with stereotactically planned ventriculoperitoneal shunt placement

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