Update on the application of optic nerve sheath fenestration

Chen, Hui; Zhang, Qian; Tan, Song; Fu, Huazhu; Farris, Bradley K.; Yang, Zhenglin

doi:10.3233/rnn-160693

Cited by 12 publications

(8 citation statements)

References 60 publications

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“…For these patients, ONSF may be a safe and effective alternative to protect visual function. 43 After antithrombotic therapy, the majority of CVST cases with APS showed good response to antithrombotic therapy without recurrence, and 84.2% achieved favorable prognosis with mRS of 0-2 with active treatment. Unfortunately, 3 patients (15.8%) died of cerebral herniation due to acute hemorrhagic lesion, higher than the previous study (4.39%).…”

Section: Discussionmentioning

confidence: 91%

Clinical Characteristics and Management of Cerebral Venous Sinus Thrombosis in Patients With Antiphospholipid Syndrome: A Single-Center Retrospective Study

Shen

Huang

Fan

2021

Clin Appl Thromb Hemost

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Antiphospholipid syndrome (APS) with cerebral venous sinus thrombosis (CVST) is a relatively rare phenomenon, and this observational study aimed to investigate the clinical characteristics of APS patients complicated with CVST. We retrospectively investigated the clinical characteristics of CVST events in APS and compared differential characteristics and associated factors between APS patients with and without CVST. Twenty-one CVST patients with APS were enrolled including 14 females (9.4%) and 7 males (5.8%). The median age and disease duration at onset of CVST was 33 years (IQR 28-48) old and 1.3 months (IQR 0.7-4), respectively. Among APS patients with CVST, 12 (57.1%) cases presented with neurologic symptoms of CVST as the initial manifestation. Onset of CVST was mainly chronic (52.4%). Headache (90.5%) was the most common neurological symptom. The common locations of CVST were transverse sinus (76.2%) and superior sagittal sinus (57.1%), with more frequently (76.2%) dual or multiple sinuses involved. All patients with CVST were treated with anticoagulant, and 5 (23.8%) patients received endovascular therapy. Sixteen (84.2%) patients had good outcomes and 3 (15.8%) patients died at last follow-up. There were no significant differences ( P > 0.05) between two groups in the analysis of related APS indicators. There were no significant differences ( P > 0.05) between two groups in the analysis of related APS indicators. Although APS complicated with CVST is rare and predominately chronic developed. The evaluation of CVST should be performed for APS patients with intracranial hypertension syndrome. The routine screening of antiphospholipid antibodies (aPLs) is highly recommended in unexplained CVST patients. Most CVST patients with APS will have a good prognosis after treatment, and endovascular therapy is an alternative treatment.

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Section: Discussionmentioning

confidence: 91%

Clinical Characteristics and Management of Cerebral Venous Sinus Thrombosis in Patients With Antiphospholipid Syndrome: A Single-Center Retrospective Study

Shen

Huang

Fan

2021

Clin Appl Thromb Hemost

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“…Modern ONSF is a remarkably safe and effective procedure performed on an outpatient basis for patients with vision threatening papilledema. 8,[15][16][17][18][19][20][21][22][23][24] Although ONSF does not significantly change ICP 25,26 , it does effectively decompress the optic nerve sheath locally leading to stabilization or improvement in vision. 1,2,8,15,22,[25][26][27][28][29] The functional mechanism of ONSF has been debated.…”

Section: Discussionmentioning

confidence: 99%

“…8,[15][16][17][18][19][20][21][22][23][24] Although ONSF does not significantly change ICP 25,26 , it does effectively decompress the optic nerve sheath locally leading to stabilization or improvement in vision. 1,2,8,15,22,[25][26][27][28][29] The functional mechanism of ONSF has been debated. 18 One theory posits that fenestration works via subarachnoid scarring at the site of fenestration and subsequent shifting of the intracranial pressure gradient to a more posterior portion of the optic nerve.…”

Section: Discussionmentioning

confidence: 99%

Optic nerve sheath fenestration: a revised lateral approach for nerve access

Blessing

Tse

2018

Orbit

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Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, describes a disease of poorly understood pathophysiology with a specific set of signs and symptoms including potentially irreversible and blinding visual loss. Optic nerve sheath fenestration (ONSF) is a well-described surgical treatment for patients with IIH and progressive visual loss despite maximally tolerated medical therapy. A number of optic nerve access procedures have been described including medial transconjunctival, superomedial lid crease, and lateral orbitotomy with and without bone takedown. The purpose of this report is to describe a revised lateral approach for temporal optic nerve access that obviates the need to traverse through the intraconal fat of the central surgical space in the previously described lateral approach techniques.

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“…Except for cerebral venous diseases, ONSF is widely applicated in papilledema due to IIH, cryptococcal meningitis, chronic inflammatory demyelinating polyneuropathy, intracranial mass or tumors, shunt malfunction ( 25 – 27 ). Although studies have reported that unilateral ONSF significantly decreases the grade of papilledema in both ipsilateral (operated) and contralateral (unoperated) eyes ( 28 , 29 ), whether or not to operate on both eyes depends on the doctor and patient's condition.…”

Section: Treatments Of Visual Impairment Caused By Intracranial Hyper...mentioning

confidence: 99%

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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Update on the application of optic nerve sheath fenestration

Cited by 12 publications

References 60 publications

Clinical Characteristics and Management of Cerebral Venous Sinus Thrombosis in Patients With Antiphospholipid Syndrome: A Single-Center Retrospective Study

Clinical Characteristics and Management of Cerebral Venous Sinus Thrombosis in Patients With Antiphospholipid Syndrome: A Single-Center Retrospective Study

Optic nerve sheath fenestration: a revised lateral approach for nerve access

Optic nerve sheath fenestration for visual impairment in cerebral venous diseases

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