Visual recovery after unilateral optic nerve sheath fenestration for pseudotumor cerebri syndrome

ABSTRACT

Purpose

To evaluate the effect of optic nerve sheath fenestration (ONSF) on the rate of visual function improvement in patients with pseudotumor cerebri syndrome (PTCS).

Methods

Retrospective chart review of patients with PTCS who underwent ONSF between 1998 and 2017. Visual function was evaluated by evaluating visual field (VF), mean deviation (MD), retinal nerve fiber layer (RNFL) thickness, papilledema grade, and visual acuity (VA) prior to and after ONSF.

Results

Seventeen female patients aged 17 to 36 years underwent unilateral ONSF. Follow-up averaged 40.1 months. VF MD improved steadily in both eyes up to 12 months. Average RNFL thickness improved in the operated eye from 347 ± 166 mm to 92 ± 27 mm (p < .001) and the non-operated eyes from 306 ± 165 mm to 109 ± 46 mm (p < .001). The grade of papilledema improved in the operated eye from 3.3 ± 1.3 to 0.3 ± 0.7 and the non-operated eye from 3.0 ± 1.6 to 0.18 ± 0.4. There was an exponential rate of improvement in papilledema and RNFL thickness, with the greatest improvement occurring within the first 30 days. Average visual acuity remained intact in both eyes before and after surgery.

Conclusions

ONSF in appropriately selected patients leads to rapid improvement in papilledema and a steady recovery in VF.

KEYWORDS:

• Headaches
• idiopathic intracranial hypertension
• intracranial pressure
• optic nerve sheath fenestration
• pseudotumor cerebri

Acknowledgments

The authors thank Carol Spencer, Lahey Hospital Librarian, for research support. David J. Ramsey is the Harry N. Lee Family Chair in Innovation at the Lahey Hospital & Medical Center, Beth Israel Lahey Health.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Meeting presentation

This study will be presented at the American Society of Ophthalmic Plastic & Reconstructive Surgery Fall Scientific Symposia 2022.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/01676830.2022.2118791.

Additional information

Funding

D.J.R.: Supported by the Harry N. Lee Family Chair in Innovation at the Lahey Hospital & Medical Center, Beth Israel Lahey Health.