Pediatric and adult vision restoration after optic nerve sheath decompression for idiopathic intracranial hypertension

Abstract

To compare presentations of idiopathic intracranial hypertension and efficacy of optic nerve sheath decompression between adult and pediatric patients, a retrospective cohort study was completed All idiopathic intracranial hypertension patients undergoing optic nerve sheath decompression by one surgeon between 1991 and 2012 were included. Pre-operative and post-operative visual fields, visual acuity, color vision, and optic nerve appearance were compared between adult and pediatric (<18 years) populations. Outcome measures included percentage of patients with complications or requiring subsequent interventions. Thirty-one adults (46 eyes) and eleven pediatric patients (18 eyes) underwent optic nerve sheath decompression for vision loss from idiopathic intracranial hypertension. Mean deviation on visual field, visual acuity, color vision, and optic nerve appearance significantly improved across all subjects. Pre-operative mean deviation was significantly worse in children compared to adults (p=0.043); there was no difference in mean deviation post-operatively (p=0.838). Significantly more pediatric eyes (6) presented with light perception only or no light perception than adult eyes (0) (p=0.001). Pre-operative color vision performance in children (19%) was significantly worse than in adults (46%) (p=0.026). Percentage of patients with complications or requiring subsequent interventions did not differ between groups. The consistent improvement after surgery and low rate of complications suggest optic nerve sheath decompression is safe and effective in managing vision loss due to adult and pediatric idiopathic intracranial hypertension. Given the advanced pre-operative visual deficits seen in children, one might consider a higher index of suspicion in diagnosing, and earlier surgical intervention in treating pediatric idiopathic intracranial hypertension.

Optic Nerve Sheath Fenestration for Progressive Visual Loss in Cerebral Venous Sinus Thrombosis: A Long-Term Retrospective Observational Study

“…Many studies have verified ONSF safety in IIH, especially after 2000, with surgical procedures development and new instruments application. Compared with the relatively high complication rates of 44.7% and 45.3% reported, respectively, in 1993 [27] and 2000 [10], the complication rate decreased significantly, ranging from 2.6 to 23.0% [28,29]. Most complications thereafter have been transient and benign without severe sequelae, as summarized in Table 3 [10][11][12][13][27][28][29].…”

Infantile idiopathic intracranial hypertension: case report and review of the literature

“…In case of rapid worsening of visual function despite adequate medical therapy, neurosurgical interventions may be needed, such as fenestration of the optic nerve, or lumboperitoneal or ventriculoperitoneal shunt [ 24 ].…”

Pseudotumor Cerebri Syndrome in Children

“…These interventions should be considered as part of the acute management, and should not replace long-term management strategies such as weight loss or modification of underlying risk factors. Surgical options most commonly employed in PTCS include optic nerve sheath fenestration; the role of CSF shunting (lumboperitoneal or ventriculoperitoneal) and neurovascular (venous sinus) stenting has not yet been established in adults or children, and carries risk of significant morbidity [33,64].…”