Optic Nerve Sheath Decompression Research Articles

Endoscopic endonasal optic nerve sheath decompression (EONSD) for idiopathic intracranial hypertension: Technical details and meta-analysis

BackgroundThe neurosurgical management of idiopathic intracranial hypertension (IIH) remains controversial. Although shunting and newer endovascular stenting techniques are part of the neurosurgical armamentarium to treat medically refractory IIH symptoms, optic nerve sheath fenestration has traditionally been performed by ophthalmologists. ObjectiveWe present a detailed cadaveric dissection that simulates the endoscopic endonasal optic nerve sheath decompression (EONSD) technique along with the literature review. MethodsEONSD was performed in four freshly injected cadaveric specimens. Additionally, a systematic review from different electronic databases has been done. ResultsBilateral EONSD was performed in all specimens without significant technical difficulties. Based on our experience, there is no need to expose the periorbita or orbital apex. The primary anatomic landmarks were the optic canal, the lateral opticocarotid recess, the tuberculum, the limbus, and the clinoid segment of the internal carotid artery. Based on the systematic review, 68 patients (77.9% female) underwent EONSD, with a mean age of 33.4 ± 6.9 years in adult patients. Follow-up ranged from 3 to 58 months across different studies. The pooled meta-analysis showed headache, papilledema, and visual disturbance improvement in 78% [95%CI 0.65–0.90], 72% [95%CI 0.61–0.83], and 88% [95%CI 0.80–0.96] of cases who underwent EONSD, respectively. The subgroup analysis showed there was no statistically significant difference between unilateral and bilateral EONSD in terms of different measured outcomes. ConclusionEONSD is a feasible surgical procedure that may obviate the need for shunting in patients with IIH. Although clinical studies showed that EONSD is a safe and effective technique, further studies are required to establish the preferences of either unilateral or bilateral approaches.

Pathogenesis of Terson syndrome.

The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial. The central retinal artery (in 39 orbits), posterior ciliary arteries (in 8 orbits), and central retinal vein (CRV in 21 orbits) were occluded in rhesus monkeys by exposing them to lateral orbitotomy. Fundus examination and fluorescein fundus angiography were performed before and immediately after cutting the vessels and serially thereafter during the follow-up period. The rationale of the experimental study design is discussed. In eyes with central retinal artery occlusion, retinal hemorrhages were seen soon after the procedure in 7 eyes, and on follow-up in a total of 15 eyes. In posterior ciliary artery occlusion, retinal hemorrhages were seen soon after the procedure in one eye, and on follow-up in a total of three eyes. In eyes with CRV, all eyes had extensive scattered retinal hemorrhages. The findings of this experimental study, and my basic, experimental, and comprehensive clinical studies on CRVO, suggest the following concept of the pathogenesis of TS: Compression of the CRV plays a crucial role in the development of TS. The CRV is compressed, as it lies in the subarachnoid space of the optic nerve sheath, by raised cerebrospinal fluid pressure and/or accumulated blood. venous stasis and raised venous pressure in the retinal veins, leading to venous engorgement, rupture of the retinal capillaries. retinal hemorrhages. The clinical importance of compression of the CRV and not occlusion of CRV in TS is that optic nerve sheath decompression by opening it and releasing the blood and raised cerebrospinal fluid (CSF) pressure, would result in immediate decompressing of the CRV in the subarachnoid space and restoration of normal circulation and prevent visual loss.

A 270-Degree Decompression of Optic Nerve in Refractory Idiopathic Intracranial Hypertension Using an Ultrasonic Aspirator - A Prospective Institutional Study.

Although the nonsurgical treatment for idiopathic intracranial hypertension (IIH) involves weight loss, diuretics, and steroids, surgical intervention is required if there is a worsening of symptoms or visual deterioration. To determine the efficacy and complications of transcranial optic nerve sheath fenestration (ONSF) using an ultrasonic aspirator as an adjunct in the treatment of refractory IIH. This prospective study included all patients with medically refractory IIH with visual deterioration from November 2017 to June 2019. Pterional craniotomy was followed by extradural clinoidectomy and optic foramen bony decompression using an ultrasonic aspirator. All the cases were followed up for changes in visual acuity and field and surgical outcomes. A total of 21 consecutive patients who underwent ONSF in the study period were included for analysis. Improvement in visual acuity was noted in 19/21 (90.47%) patients. Improvement in visual fields was noted in 17/21 (80.95%). Headache improved in 66.67% of patients. Improvement in the fundus picture was noted in 90.47%. Symptoms < 6 months showed better results compared to > 6 months symptom, although statistically nonsignificant (P = 0.2556). A 270-degree optic canal decompression was achieved in all the cases. Transcranial optic nerve sheath decompression with a bone ultrasonic aspirator is a safe and direct decompression of the optic nerve in malignant/refractory cases of IIH.

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

To report the outcome of optic nerve sheath decompression (ONSD) for papilloedema in a teaching hospital in western Turkey. 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. Of all study eyes, 49 (43.7%) eyes had BCVA 0.2 or less and 62 (55.3%) eyes had mean deviation (MD) below - 20.0dB. 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. 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.

Superonasal Transconjunctival Optic Nerve Sheath Decompression: A Simplified Technique for Safe and Efficient Decompression.

Severe, permanent vision loss is a feared sequela of untreated or refractory idiopathic intracranial hypertension (IIH). For patients with progressive vision loss despite maximally tolerated medical treatment, optic nerve sheath decompression (ONSD) remains a viable and effective option to protect vision. Our objective is to introduce a modified transconjunctival technique for ONSD and determine its safety, efficacy, and efficiency in patients with IIH. We performed analyses for a retrospective case series of consecutive patients with IIH by modified dandy criteria who underwent isolated superonasal transconjunctival optic nerve sheath decompression (stOND) at single eye institute in a large academic center from January 2013 to February 2017. Sixty-six patients were identified who met these criteria with at least 6 weeks of follow-up data. Primary outcome measures were visual field mean deviation, grading of papilledema by the modified Frisen scale, and best-corrected visual acuity. Secondary outcome measures were presence of postoperative diplopia and operative time. One hundred thirty-two eyes of 66 patients were identified; 58 were female (88%), and 8 were male (12%). The mean age was 30 years (range 13-55) with an average lumbar puncture opening pressure of 38 cm H2O. Participants mean body mass index was 36 (range 20-59) with Grade 3 papilledema on average by the modified Frisen scale. No patients experienced operative complications, postoperative diplopia, or worse visual acuity at 1 week after surgery. Average operative time was 50 minutes (range: 25-89). The median decrease in papilledema grading was 3 grades on the Frisen scale (95% confidence interval [CI], 2-3, P < 0.0001). Snellen visual acuity changes did not meet statistical significance. The average Humphrey Visual Field mean deviation change was +1.91 (95% CI, 0.58-3.24, P = 0.0052). Despite successful bilateral decompressions, 4 patients (6.1%) progressed in their visual loss. The superonasal transconjunctival approach to ONSD is a safe, efficient and effective surgical treatment for patients with deteriorating visual function due to IIH. Although additional study is required to further clarify the best timing and indications for ONSD among other treatment options for refractory IIH, providers should be aware of the reduced complication rates and efficacy of the stOND technique.

Fulminant Idiopathic Intracranial Hypertension and Venous Stasis Retinopathy Resulting in Severe Bilateral Visual Impairment

To report a complicated case of fulminant idiopathic intracranial hypertension and concomitant venous stasis retinopathy leading to postpapilledema optic atrophy. Case report. A 34-year-old morbidly obese woman with a history of idiopathic intracranial hypertension (IIH) presented with a 1-month history of bilateral vision loss, diplopia, and left eye pain after being lost to follow-up for 6 years. Fundus examination revealed florid papilledema with venous tortuosity bilaterally. Brain and orbit magnetic resonance imaging showed bilateral globe flattening, intraocular optic nerve swelling in both eyes, and no abnormality on magnetic resonance venography. After additional workup including lumbar puncture with an opening pressure of 55 cm H2O, a diagnosis of IIH was confirmed. Medical treatment with oral carbonic anhydrase inhibitors was initiated, followed by same-day bilateral optic nerve sheath decompression and ventriculoperitoneal shunt placement the following week. Fundus examination 2 months later revealed a persistent blood and thunder fundus suggestive of bilateral central retinal vein occlusions. Over the course of 6 months, both eyes displayed postpapilledema optic atrophy with light perception and hand motion vision in the right and left eyes, respectively. On Goldmann perimetry, the patient had vague limited isolated responses in both eyes to the largest target. Fulminant IIH can present with profoundly blinding complications recalcitrant to aggressive medical and surgical intervention. Central retinal vein occlusion is an uncommon blinding complication of IIH.

The Relationship Between Optic Nerve Sheath Decompression Failure and Intracranial Pressure in Idiopathic Intracranial Hypertension.

To our knowledge, there are no studies of patients with idiopathic intracranial hypertension (IIH) that address the relationship between level of intracranial pressure (ICP) and likelihood of progressive visual loss despite uncomplicated optic nerve sheath decompression (ONSD). This study investigated whether patients with IIH undergoing ONSD had a higher risk of surgical failure if opening pressure (OP) on lumbar puncture was ≥50 cm H2O compared to those with OP <50 cm H2O. We conducted a retrospective chart review of consecutive patients with IIH who failed maximal medical therapy and underwent ONSD between January, 1992 and November, 2014, and were followed at least 3 months postoperatively. The main outcome measure was the relationship between OP on lumbar puncture and ONSD failure. We also investigated the relationship of OP with visual acuity, visual fields, age, and gender. During this period, 174 patients met inclusion criteria. Of the 40 patients who had an OP ≥50 cm H2O, 6 (15%) had progressive visual loss after uncomplicated ONSD, vs 6 (4.5%) of 134 patients with an OP <50 cm H2O (P = 0.032, Fisher exact test). Patients with worse visual acuity at presentation also had a higher risk of progressive visual loss after ONSD (P < 0.001, Cochran-Armitage trend test), as did men (P = 0.048, Fisher exact test). Patients with IIH and an OP ≥50 cm H2O had a 3-fold increased risk of failure of ONSD to prevent progressive visual loss, requiring a shunting procedure when compared to those with OP <50 cm H2O. Visual acuity at presentation and male sex also were associated with progressive visual decline after ONSD. These risk factors merit closer follow-up in the postoperative period when signs of further visual deterioration would indicate an urgent need for neurosurgical shunting.

Farris–Tang retractor in optic nerve sheath decompression surgery

ABSTRACTPurpose: Our purpose is to introduce the use of the Farris–Tang retractor in optic nerve sheath decompression surgery.Methods: The procedure of optic nerve sheath fenestration was reviewed at our tertiary care teaching hospital, including the use of the Farris–Tang retractor.Results: Pseudotumor cerebri is a syndrome of increased intracranial pressure without a clear cause. Surgical treatment can be effective in cases in which medical therapy has failed and disc swelling with visual field loss progresses. Optic nerve sheath decompression surgery (ONDS) involves cutting slits or windows in the optic nerve sheath to allow cerebrospinal fluid to escape, reducing the pressure around the optic nerve. We introduce the Farris-Tang retractor, a retractor that allows for excellent visualization of the optic nerve sheath during this surgery, facilitating the fenestration of the sheath and visualization of the subsequent cerebrospinal fluid egress. Utilizing a medial conjunctival approach, the Farris–Tang retractor allows for easy retraction of the medial orbital tissue and reduces the incidence of orbital fat protrusion through Tenon’s capsule.Conclusion: The Farris–Tang retractor allows safe, easy, and effective access to the optic nerve with good visualization in optic nerve sheath decompression surgery. This, in turn, allows for greater surgical efficiency and positive patient outcomes.

Idiopathic intracranial hypertension: case report

Abstract Idiopathic intracranial hypertension - IIH (synonymous old terms: benign intracranial hypertension - BIH, pseudotumor-cerebri - PTC) it’s a syndrome, related to elevated intracranial pressure, of unknown cause, sometimes cerebral emergency, occuring in all age groups, especially in children and young obese womans, in the absence of an underlying expansive intracranial lesion, despite extensive investigations. Although initial symptoms can resolve, IIH displays a high risk of recurrence several months or years later, even if initial symptoms resolved. Results: A 20-year-old male, obese since two years (body mass index 30, 9), was admitted for three months intense headache, vomiting, diplopia, progressive visual acuity loss. Neurologic examination confirmed diplopia by left abducens nerve palsy, papilledema right &gt; left. At admission, cerebral CT scan and cerebral MRI with angio MRI 3DTOF and 2D venous TOF was normal. Despite treatment with acetazolamide (Diamox), corticosteroid, antidepressants (Amitriptyline), anticonvulsivants (Topiramate) three weeks later headache, diplopia persist and vision become worse, confirmed by visual field assessment, visual evoked potential (VEP). A cerebral arteriography demonstrate filling defect of the superior sagittal sinus in the 1/3 proximal part and very week filling of the transverse right sinus on venous time. Trombophylic profile has revealed a heterozygote V factor Leyden mutation, a homozygote MTHFR and PAI mutation justifying an anticoagulant treatment initiated to the patient. The MRI showed a superior sagittal sinus, right transverse and sigmoid sinus thrombosis, dilatation and buckling of the optic nerve sheaths with increased perineural fluid especially retrobulbar, discrete flattening of the posterior segment of the eyeballs, spinal MRI showed posterior epidural space with dilated venous branches, with mass effect on the spinal cord, that occurs pushed anterior on sagittal T1/T2 sequences cervical and thoracic. The opening pression of lumbar puncture, done with the patient in the lateral decubitus position, was 60 cm H2O, the cytochemical CSF study were normal. The patient was operated: a lombo-peritoneal with a variable pressure valve was inserted. Two months after the patient general condition improved: he was without headache, abducens palsy and the visual field assessment, ocular motility examination, ophthalmoscopy were normal. Conclusion: IHH is rare, variable in evolution, and in many cases it disappears on its own within 6 months without affecting life expectancy. Weight loss, fluid or salt restriction, in conjunction with medical treatment, angioplasty and venous stenting across the sinus stenosis under general anesthesia and surgical treatment (shunting, optic nerve sheath decompression and fenestration, gastric by-pass surgery) are treatment alternatives. Such disorder should be closed monitored because 10 to 25% of cases could be affected by recurrencies or by permanent vision loss to those patients with resistant papilledema despite treatment.

Optic Nerve Sheath Decompression

The purpose of this study was to determine the safety and efficacy of optic nerve sheath decompression (ONSD) with a medial transconjunctival approach for a variety of indications in a larger population of patients than has previously been reported. A retrospective chart review was performed on consecutive patients who underwent ONSD between January 1992 and December 2010. Before ONSD, all patients had documented evidence of progressive loss of visual acuity or visual field, or both. Postoperative follow-up visits were scheduled at 1 week, 1 month, and then every 3-6 months. Main outcome measures were visual acuity, visual fields, and surgical complications. Five hundred seventy-eight eyes of 331 patients underwent ONSD for progressive vision loss due to various indications, which included but were not limited to idiopathic intracranial hypertension (IIH), progressive nonarteritic ischemic optic neuropathy, and optic nerve drusen (OND). During a mean follow-up of 18.7 months (range, 1 week to 10 years), postoperative visual acuity remained stable or improved in 536 of 568 eyes (94.4%) and progressively worsened in 32 of 568 eyes (5.6%). Visual fields remained stable or improved in 257 of 268 eyes (95.9%) and progressive visual field loss occurred in 11 of 268 eyes (4.1%). There were no reported intraoperative complications. The most common postoperative complication was diplopia (6.0%). To our knowledge, this review represents the largest series of patients who have undergone ONSD for any indication. Our data are consistent with current literature supporting ONSD as a safe and effective procedure for IIH. Other indications for ONSD, such as progressive visual field loss associated with OND, warrant further study. Regardless of the indication, complications following ONSD with the technique described in this report are infrequent.

Pseudotumor cerebri: an update on treatment options.

Aims:The aim was to identify Pseudotumor cerebri treatment options and assess their efficacy.Setting and Design:Review article.Materials and Methods:Existing literature and the authors’ experience were reviewed.Results:Treatment options range from observation to surgical intervention. Weight loss and medical treatment may be utilized in cases without vision loss or in combination with surgical treatment. Cerebrospinal fluid shunting procedures and/or optic nerve sheath decompression is indicated for severe vision loss or headache unresponsive to medical management. The recent use of endovascular stenting of transverse sinus stenoses has also demonstrated benefit in patients with pseudotumor cerebri.Conclusion:While each treatment form may be successful individually, a multimodal approach is typically utilized with treatments selected on a case-by-case basis.

Outcomes of Optic Nerve Sheath Decompression for Visual Loss in Idiopathic Intracranial Hypertension

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.

Inpatient and Emergency Services Utilization in Idiopathic Intracranial Hypertension (P07.253)

Objective: To determine the coding validity of the ICD-9 code for IIH, and describe the use of inpatient and emergency services related to IIH. Background Patients with IIH may seek care in the emergency department (ED) and sometimes require hospitalization. The magnitude of ED and inpatient use is difficut to assess; data are collected nationwide regarding hospital-based visits using the ICD-9 code for IIH (348.2), the code has never been validated. Design/Methods: We reviewed ED and inpatient encounters from patient (ages >18) charts coded with a diagnosis of IIH, optic nerve sheath decompression, or lumboperitoneal shunting. We recorded patient demographics, reason for the encounter, diagnostic testing and procedures performed and hospital chareges. We calculated the positive predictive value (PPV) of the ICD-9 code for IIH. Results: 137 visits from 51 patients were identified. The majority of encounters occurred in the ED (68%), with 40% of those converted to inpatient admissions. 94% of patients were seen in the ED at least once. The use of ED services increased from 10/year in 2007-2010. Encounters resulted from recurrent IIH symptoms IIH (43%), surgical complications (26%) and initial presentation (12%). The PPV of the ICD-9 code was 50%. Patients averaged nearly 3 visits each over the 10 year study period. Conclusions: The use of the ED by patients with IIH for IIH-related issues increased over the 10-year study period. This may be attributable to the increasing rates of obesity in the population, heightened awareness of the disorder by medical professionals, timeliness of access in the ED compared to outpatient care, insurance coverage, and increasing usage of shunt procedures which often require revision. Consistent with previous reports, surgical complications were common, accounting for 26% of hospital admissions from the ED. The 348.2 diagnosis code may not be a reliable indicator of utilization of IIH-related services. Disclosure: Dr. Friedman has received personal compensation for activities with MAP Pharmaceuticals, MAP Pharmaceuticals, and Allergan, Inc. Dr. Friedman has received personal compensation in an editorial capacity for Neurology Reviews. Dr. Friedman has received research support from Amplatzer, Merck & Co., Inc., Quark Pharmaceuticals, MAP Pharmaceuticals, Pfizer, Inc, and National Eye Institute. Dr. Koerner has nothing to disclose.

Endovascular Stenting of Venous Sinus Stenosis for Idiopathic Intracranial Hypertension

T M w b s t m I n their article, Albuquerque et al. add to a growing body of literature supporting the role of venous sinus stenting for sinus stenosis in idiopathic intracranial hypertension (IIH). It is a elcome addition to a new approach to treatment for patients with IH, many of whom can be notoriously difficult to treat and resilient o interventions. There is controversy in every facet of this disease, rom the causation, pathophysiology, the relationship between enous sinus stenosis and the intracranial hypertension, and the ost efficacious treatment for IIH. Most of the other surgical reatments of IIH, including ventriculoperitoneal and lumboperitoeal shunting, optic nerve sheath decompression, and bilateral ubtemporal decompression, aim toward the treatment of the high ntracranial pressure (ICP) or its sequelae, most important of which s papilledema and visual loss. Venous sinus stenting, if widely ccepted as the treatment of choice, will be the first modality to ttempt treating the causative factor of the disease. However, the ause and effect relationship between venous sinus stenosis and IH is unproven.

Outcomes of Optic Nerve Sheath Decompression for Visual Loss in Idiopathic Intracranial Hypertension

Outcomes of Optic Nerve Sheath Decompression for Visual Loss in Idiopathic Intracranial Hypertension

Visual Improvement After Optic Nerve Sheath Decompression in a Case of Congenital Hydrocephalus and Persistent Visual Loss Despite Intracranial Pressure Correction Via Shunting

Among the sequelae of persistent raised intracranial pressure (ICP) are ophthalmologic signs and symptoms, including cranial nerve palsies, visual field deficits, papilledema, and vision loss. Elevated pressure within the optic nerve sheath may not be relieved by shunt procedures, which can decrease generalized ICP. The authors present a case of acute visual loss in the setting of chronic hydrocephalus and multiple shunt revisions. Despite shunt correction resolving systemic symptoms of raised ICP, this child had persistent visual loss. Bilateral optic nerve sheath decompression was performed, and the visual acuity improved over the next 3 days. This case highlights the importance of routine ophthalmologic examination in patients with hydrocephalus and shunts and demonstrates the utility of optic nerve sheath decompression as a surgical intervention when shunting alone does not resolve visual loss.

Should Steroids be Offered to Patients With Nonarteritic Anterior Ischemic Optic Neuropathy?

The treatment of nonarteritic anterior optic neuropathy remains very limited and disappointing. Recent publications have suggested that oral steroids as well as intravitreal injections of steroids might be helpful to accelerate resolution of disc edema and improve visual outcome. However, the use of steroids to treat acute NAION remains largely debated.

Localized Cystic Enlargement of the Distal Optic Nerve Sheath after Decompression Surgery.

Cystic formation of the optic meninges may occur after optic nerve sheath decompression surgery for the management of pseudotumor cerebri. A case with a cyst-like structure of the distal optic nerve sheath at the operation site in the late surgical period after nerve sheath decompression surgery is reported.

Vertical lid split approach for optic nerve sheath decompression

We describe a vertical lid split orbitotomy approach to perform optic nerve sheath fenestration which was done in a patient with idiopathic intracranial hypertension. A vertical lid split incision was used to enter the superomedial orbit and approach the optic nerve sheath. This approach resulted in a successful nerve sheath fenestration, with improvement in the patient's symptoms. The vertical lid split incision provides access to the optic nerve sheath with minimal morbidity and may be an option for optic nerve sheath decompression.

Idiopathic intracranial hypertension in pediatric patients

To evaluate retrospectively the features, treatment, and outcome of idiopathic intracranial hypertension (IIH) in children. Nine patients, 15 years and younger, diagnosed with IIH. Inclusion criteria were papilledema, normal brain computer tomography or magnetic resonance imaging, cerebrospinal fluid pressure greater than 250 mm H(2)O, normal cerebrospinal fluid content, and a nonfocal neurologic examination except for sixth nerve palsy. Of the nine patients, eight were girls. Five girls were overweight and one boy was obese. The most common presenting symptom was headache (5 patients). Diplopia or strabismus did not occur in our group. Visual field abnormalities were present in all eyes, and severe visual loss resulting in light perception vision occurred in both eyes of one patient. Eight patients were treated medically with acetazolamide alone, and one girl needed a combination of acetazolamide and corticosteroids. This girl also required optic nerve sheath decompression surgery. Resolution of papilledema and recovery of visual function occurred in all patients. Idiopathic intracranial hypertension in prepubertal children is rather uncommon. Prompt diagnosis and management are important to prevent permanent visual loss.