Effect of Optic Nerve Sheath Fenestration on Papilledema of the Operated and the Contralateral Nonoperated Eyes in Idiopathic Intracranial Hypertension

Alsuhaibani, Adel H.; Carter, Keith D.; Nerad, Jeffrey A.; Lee, Andrew G.

doi:10.1016/j.ophtha.2010.06.025

Cited by 83 publications

(40 citation statements)

References 15 publications

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“…In this study, there was a clinical relapse in 11 of 86 patients (13%), which occurred after an unpredictable time course up to five years post-operatively (similarly to our population). Although more of the ONSF cases underwent bilateral procedures in this series (84% versus 35%), recent data from Alsuhaibani et al 11 suggests that fellow eye response to ONSF may be greater than previously thought, and that both optic nerve oedema and VF stability are improved in fellow eyes of patients undergoing unilateral ONSF.…”

Section: Discussionmentioning

confidence: 53%

Long-Term Results of Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension: Earlier Intervention Favours Improved Outcomes

Pineles¹,

Volpe²

2013

Neuro-Ophthalmology

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The role of optic nerve sheath fenestration (ONSF) in the management of idiopathic intracranial hypertension remains controversial, with indications, risks, and benefits compared to cerebro-spinal fluid diversion procedures not fully elucidated. We report a retrospective record review of 37 patients (50 eyes) which had undergone ONSF by a single surgeon. Visual acuity (VA) improved in 22% of operated eyes and 17% of fellow eyes; stabilized in 54% of operated and 74% of fellow eyes; and deteriorated in 24% of operated and 9% of fellow eyes. Better pre-operative VA (p ¼ 0.01), colour vision (p ¼ 0.002), and earlier intervention (p ¼ 0.04) were associated with stabilization. We conclude that ONSF often stabilizes vision and visual fields. Our results were best in patients with better pre-operative vision and in those with earlier intervention.

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Section: Discussionmentioning

confidence: 53%

Long-Term Results of Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension: Earlier Intervention Favours Improved Outcomes

Pineles¹,

Volpe²

2013

Neuro-Ophthalmology

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“…It was not possible to evaluate the patient again at the recovery room because the operated eye was covered for one day, and she returned to the previous Clinic to be followed by her physicians. A later new evaluation showed a remission in the symptoms and could demonstrate a reduction in of ONSD as figures in the literature [2,4,6]. It is known that the reduction of the bilateral papilledema occurs around the 3 at 6 months after the operation, prior in the operated eye than in the non-operated eye.…”

Section: Discussionmentioning

confidence: 53%

“…The reduction of grade of papilledema in operated eyes was greater than in nonoperated eyes, but nonoperated eyes also experienced significant reduction in the disc edema grade with the correct time [1,2]. Until this moment the mechanism for this bilateral surgical effect is not certain and could be related to decrease the CSF in both optic nerves sheath after unilateral ONSF, regression toward the mean [6].…”

Section: Discussionmentioning

confidence: 97%

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Demonstration of Optic Nerve Sheath Fenestration Success by Ultrasound Nerve Sheath Diameter assessment. A Case Report

Vidal

2017

JACCOA

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The aim of this study is to demonstrate the correlation between the decrease of the Ophthalmic Nerve Sheath Diameter (ONSD) assessed by Ultrasound after a Surgery of Optic Nerve Sheath Fenestration (ONSF) for the treatment of a Idiopathic Intracranial Hypertension (IIH) and its success in the perioperative period. A 21 year-old female diagnosed with IIH was scheduled for unilateral ONSF surgery. We evaluated the ONSD after and before the surgery. The measurements were: 71,5mm mean for the both eyes BEFORE the surgery (71,5mm for the LE and 71,5mm for the RE respectively) and 57,25mm, fifteen minutes AFTER the fenestration of the LE Optic Nerve Sheath (RE: 70mm LE: 44,5mm means). There was a difference in the Optic sheath in the Operated Left Eye (ONSD 54-35 mm) and we could estimate the location of the fenestration in the images. We think this is the ideal method to evaluate the response to the surgical treatment for the IIH patients as non-invasive, low cost and in-site technique. Having agreed consent for use of data and images we made an assessment of ONSD after the induction of the general anaesthesia for the surgery. Measurements were made applied the probe over the closed upper eyelid. A 10-MHz linear probe (Turbo, Sonosite, Bothell, WA) was placed with ultrasound gel over the eyelid. The two-dimensional mode was used and ONSD was measured 3mm posterior the outermost layer of the retina using the calliper of the machine and an axis perpendicular to the Nerve. CitationFor both optic nerves, two measurements were made, one in the horizontal plane and other in the perpendicular plane. The average of the two values corresponds as ONSD for each eye. For the Right Eye (RE) the measurement was 73-70mm (71,5mm average) and for the Left Eye (LE) was 75-68mm (71,5mm average). The global mean before surgery was 71,5mm.Fifteen minutes after the surgical closing of the eyelid we repeated the assessment of the ONSD and we tried to see the location of the cut in the Optic Nerve Sheath for the eye chosen by the surgeons (Figure 1 & 2). The new measurements were: RE: 70-70 mm and for the LE (the eye chosen for the fenestration): 54-35 mm. The global mean after the surgery was 57,25mm. A decrease in the sheath around the ON could demonstrate the place where the cut was made at the Nerve Sheath (Figure 2). DiscussionOptic nerve sheath fenestration provides an effective surgical treatment for patients in whom medical therapy fails. In our case, unilateral ONSF decreased the diameter of Nerve sheath in the ipsilateral (operated) eye almost immediately after the fenestration but not changes were seen in the contralateral (nonoperated) eye at the short time [2]. The reduction of grade of papilledema in operated eyes was greater than in nonoperated eyes, but nonoperated eyes also experienced significant reduction in the disc edema grade with the correct time [1,2]. Until this moment the mechanism for this bilateral surgical effect is not certain and could be related to decrease the CSF in both optic nerves sheath after ...

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“…Permanent severe visual defects are infrequent but serious complications, which can have physical, psychological and social consequences. While most studies on ONSF have rightly focused on visual acuity and visual fields for monitoring, [10,[13][14][15][16][17], visual field test results can at times be unreliable. We believe a third parameter, colour vision, is very relevant in monitoring visual function and assessing outcomes especially when visual field test results are persistently unreliable.…”

Section: Introductionmentioning

confidence: 99%

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

Ebube

Lakhani

Burns

et al. 2015

Clinical Neurology and Neurosurgery

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Effect of Optic Nerve Sheath Fenestration on Papilledema of the Operated and the Contralateral Nonoperated Eyes in Idiopathic Intracranial Hypertension

Cited by 83 publications

References 15 publications

Long-Term Results of Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension: Earlier Intervention Favours Improved Outcomes

Long-Term Results of Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension: Earlier Intervention Favours Improved Outcomes

Demonstration of Optic Nerve Sheath Fenestration Success by Ultrasound Nerve Sheath Diameter assessment. A Case Report

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

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