Abstract
Purpose: To report our experience with optic nerve sheath decompression (ONSD) for visual loss in idiopathic intracranial hypertension (IIH).Methods: Six patients (7 eyes) with idiopathic intracranial hypertension and visual loss were involved. Five women and 1 man (mean age 42 years, ranged from 12 to 65 years) were operated at the Department of Ophthalmology, University Hospital, Hradec Kralove. Surgeries were performed by a standard medial transconjunctival approach and the sheaths were cut by three incisions. We have not seen any serious intra and postoperative complications. Only one patient developed transient double vision after surgery.Results: Visual functions improved in 5 patients. In one patient permanent visual loss with optic atrophy in both eyes occurred due to long-term duration of papilledema before referral to us.Conclusions: On the basis of our results, we believe that ONSD is safe and effective treatment of patients with IIH in vision-threatening cases after thoroughly balanced assessment of possible risks and gains.
Highlights
Intracranial hypertension (IH) is a multifactorial syndrome characterized by severe headache, nausea, vomiting, transient visual obscuration and diplopia
IIH can be diagnosed only if the following criteria are met: 1) symptoms and signs attributable to increased intracranial pressure (ICP); 2) elevated ICP recorded during lumbar puncture in the lateral decubitus position; 3) normal cerebrospinal fluid (CSF) composition; 4) no imaging evidence of ventriculomegaly or a structural cause for increased ICP, such as a brain parenchymal, ventricular, meningeal, or venous sinus abnormality; and 5) no other cause of intracranial hypertension identified, such as use of certain medications [1]
We report our experience with optic nerve sheath decompression (ONSD) for visual loss in IIH
Summary
Intracranial hypertension (IH) is a multifactorial syndrome characterized by severe headache, nausea, vomiting, transient visual obscuration and diplopia. Idiopathic intracranial hypertension (IIH) is the terminology used when no underlying etiology is detected. The definition of IIH has evolved with clinical experience and advances in imaging technology. IIH can be diagnosed only if the following criteria are met: 1) symptoms and signs attributable to increased intracranial pressure (ICP); 2) elevated ICP recorded during lumbar puncture in the lateral decubitus position; 3) normal cerebrospinal fluid (CSF) composition; 4) no imaging evidence of ventriculomegaly or a structural cause for increased ICP, such as a brain parenchymal, ventricular, meningeal, or venous sinus abnormality; and 5) no other cause of intracranial hypertension identified, such as use of certain medications [1]. Idiopathic intracranial hypertension is a surprisingly common disorder. In young overweight women (the typical patients with IIH), the annual incidence is as high as 20 per 100,000 persons. Slim women, prepubescent children, and patients older than 44 years [1]
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