Optic nerve sheath fenestration for idiopathic intracranial hypertension: A seven year review of visual outcomes in a tertiary centre

Ebube, E.; Lakhani, B; Burns, J. A.; Sampath, Raghavan

doi:10.1016/j.clineuro.2015.05.020

Cited by 27 publications

(12 citation statements)

References 36 publications

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“…Some patients are treated with ONSF; however, ONSF seems to be more effective in treating symptoms specific to visual impairment and it is less effective in treating the most commonly cited symptom (headaches) [16]. ONSF was specifically shown to improve visual acuity, visual fields, and color vision.…”

Section: Discussionmentioning

confidence: 99%

Neuroendovascular Cerebral Sinus Stenting in Idiopathic Intracranial Hypertension

et al. 2019

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Idiopathic intracranial hypertension (IIH) is a rare, ill-understood disease of significant morbidity. Because the pathophysiology is poorly understood, treatment protocols are not uniform and are directed towards alleviating the most common symptoms: headache and visual loss. In this review, we analyze 25 case series, all of which included IIH patients (n = 408) who were treated with placement of a venous sinus stent. Among 342 patients who had headache, 240 patients (70.2%) had improvement or resolution of headache after the stent insertion. Of the 217 patients documented to have visual problems, visual acuity was improved or stabilized in 161 patients (74.2%). Of the 304 patients with papilledema, 257 showed resolution or improved (84.5%). Of the 124 patients who presented with pulsatile tinnitus, it was resolved in 110 patients (88.7%) after stent placement. Endovascular management of dural sinus stenosis is therefore clinically efficacious in patients with IIH who have failed medical and surgical therapy.

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Section: Discussionmentioning

confidence: 99%

Neuroendovascular Cerebral Sinus Stenting in Idiopathic Intracranial Hypertension

et al. 2019

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“…Whether papilledema grade correlates with visual outcome is controversial. 4, 26 Papilledema grade has not been found to be correlated with severity of visual impairment. 27, 28 However, it is important to note that some studies have also found that only patients who present with significant “obvious” papilledema on clinical exam ever develop significant visual impairment.…”

Section: Discussionmentioning

confidence: 93%

Contrast-Enhanced 3D-FLAIR Imaging of the Optic Nerve and Optic Nerve Head: Novel Neuroimaging Findings of Idiopathic Intracranial Hypertension

Golden¹,

Krivochenitser²,

Mathews³

et al. 2019

AJNR Am J Neuroradiol

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Background and Purpose: The sensitivity of contrast enhanced 3D FLAIR has not been assessed in patients with idiopathic intracranial hypertension (IIH). The purpose of this study was to evaluate whether hyperintensity of the optic nerve/optic nerve head on contrast enhanced 3D FLAIR imaging is associated with papilledema in patients with IIH. Materials and Methods: A retrospective review was conducted from 2012 to 2015 of patients with clinically diagnosed IIH and age and sex matched controls who had MRI imaging with CE 3D FLAIR. Two neuroradiologists graded each optic nerve/optic nerve head on a scale of 0-3. This grade was then correlated with the Frisén scale, an ophthalmologic scale used for grading papilledema from 0 (normal) – 5 (severe edema). To estimate the correlation between the MR and Frisén scores Kendall's tau coefficient was calculated. Results: 46 patients (3 males, 43 females) with IIH and 61 controls (5 males, 56 females) with normal MRIs were included in this study. For both eyes, there was moderate correlation between the two scales (OD: T=0.47, 95%CI= (0.31,0.57), OS: T=0.38, 95%CI= (0.24,0.49)). Inter-reader reliability for MR scores showed high inter reader reliability (OD: K=0.76 95%CI= (0.55,0.88), OS: K=0.87 95%CI= (0.78,0.94)). CE 3D FLAIR imaging correlates with the Frisén scale for moderate to severe papilledema and less so for mild papilledema. Conclusion: Hyperintensity of the optic nerve/optic nerve head on CE 3D FLAIR is sensitive for the detection of papilledema in patients with IIH which may be useful in a setting where prompt diagnosis is crucial.

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“…ONSD reverses papilloedema and can save sight in PTC (Pineles & Volpe 2013; Obi et al. 2015; Kalyvas et al. 2017).…”

Section: Discussionmentioning

confidence: 99%

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

Bajin

Engin

Yaman

et al. 2020

Acta Ophthalmologica

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Purpose To report the outcome of optic nerve sheath decompression (ONSD) for papilloedema in a teaching hospital in western Turkey. Methods The charts of 56 patients who had ONSD surgery between April 2007 and September 2019 were collated; and a total of 81 operated and 31 fellow eyes were included. Pre‐ and postoperative ophthalmologic examination including best‐corrected visual acuity (BCVA), colour vision (CV), visual field (VF) analysis, fundoscopic examination and demographic and medical characteristics of the patients were noted and outcomes after surgery were investigated. Results Of all study eyes, 49 (43.7%) eyes had BCVA 0.2 or less and 62 (55.3%) eyes had mean deviation (MD) below – 20.0 dB. 62 (55.3%) eyes had Frisen grade 4 or 5 papilloedema. Almost half of the eyes had severe vision loss. After ONSD, BCVA, CV and MD in both operated and fellow non‐operated eyes improved significantly (p < 0.001, p = 0.009 and p < 0.001 for operated, p < 0.001, p = 0.007 and p < 0.001 for fellow eyes, respectively). Earlier surgery and higher cerebrospinal fluid opening pressure were related to better outcomes. None of the patients had major operative complications. Conclusion Optic nerve sheath decompression can safely improve vision not only of the operated but also of the non‐operated eye, even in cases with severe vision loss from severe bilateral papilloedema. Regardless of initial VA and VF, patients may benefit from ONSD; the earlier it is done the more likely the better outcome.

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Optic nerve sheath fenestration for idiopathic intracranial hypertension: A seven year review of visual outcomes in a tertiary centre

Cited by 27 publications

References 36 publications

Neuroendovascular Cerebral Sinus Stenting in Idiopathic Intracranial Hypertension

Neuroendovascular Cerebral Sinus Stenting in Idiopathic Intracranial Hypertension

Contrast-Enhanced 3D-FLAIR Imaging of the Optic Nerve and Optic Nerve Head: Novel Neuroimaging Findings of Idiopathic Intracranial Hypertension

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

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