Endoscopic Bilateral Optic Nerve Decompression for Treatment of Idiopathic Intracranial Hypertension

Abstract

Objective: To evaluate the results of bilateral endoscopic optic nerve decompression (EOND) with the opening nerve sheath (ONS) technique in patients with idiopathic intracranial hypertension (IIH). Methods: Between the years of 2017 and 2019, we retrospectively evaluated nine IIH patients with progressive visual impairment despite medical treatment and who were treated with the EOND and ONS techniques. We also demonstrated our surgical technique recipe on postmortem human heads in a stepwise manner. Results: There were 9 patients (7 females and 2 males) between the ages of 21 and 72 included in this study, and the mean age was 40.8. All patients had an impairment in visual acuity and/or their visual field, with signs of papilledema and/or optic atrophy. The patients were followed up with for 9–48 months. Improvements in visual acuity were observed in 7 out of 9 patients (78%). Visual field defects improved in 5 out of 8 patients (62.5%). Papilledema was resolved in all patients (100%). Headaches improved in all symptomatic patients (100%). No intraoperative or postoperative complications were observed. Conclusions: EOND is a safe and effective surgical procedure in selected patients with IIH. Bilateral wide bony decompression and nerve fenestration can also be an additional benefit for headache relief. Further clinical series and long-term follow-up are needed for more precise results.

Endoscopic Endonasal Optic Nerve Decompression in Idiopathic Intracranial Hypertension: When to Implement Optic Nerve Sheath Fenestration

“…Bilateral EOND in patients with IIH has been reported in 21 patients. 3,[18][19][20] Göksu et al 20 reported visual improvement in 78%, improvement in visual field defects in 62.5%, and resolution of papilledema and headache in all their patients. Srivastava et al 19 reported satisfactory results with EOND, headache improvement in all and visual acuity improvement in 67% of patients.…”

“…5 Bilateral EOND should be preferred for cases with bilateral visual impairment especially when accompanied by headache. 20 Because anterior sphenoidotomy is routinely performed in our technique, decompression may easily be extended to the contralateral side. For the initial cases in our series, unilateral EOND was performed, after which it became evident that there is a high rate of progression of visual symptoms in the contralateral eye if it was initially symptomatic, which led to bilateral EOND being the preferred method of decompression for cases with bilateral involvement.…”

What Is the Best Surgical Intervention for Patients With Idiopathic Intracranial Hypertension?

“…A recent retrospective review of 30 patients undergoing superior medial transcutaneous surgery between 2011 and 2017 by one surgeon describes outcomes and complications over a median follow-up of 14.5 months. 19 The surgical description of a standardized window in this text is useful: the authors describe the creation of “2 relatively long, longitudinal, 5-mm incisions separated by 2 mm, with additional enlargement to 7 × 3 mm with a punch.” Bilateral ONSFs were undertaken in 27 (90%) of 30 patients. The data from 1 eye per patient were analyzed.…”

Editorial: Neurosurgery and Neuroanatomy

“…Göksu et al [6] published the clinical outcomes of endoscopic optic nerve decompression using their opening nerve sheath technique in patients with idiopathic intracranial hypertension, which resulted in an improvement in visual acuity (78%), visual field defect (62.5%), and papilledema (100%). Their surgical technique was demonstrated using cadaveric dissection and intraoperative video.…”