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Abstract
Purpose Optic nerve sheath decompression is advocated for the treatment of certain types of optic nerve dysfunction with progressive visual loss such as pseudotumor cerebri and progressive non arteritic anterior ischemic optic neuropathy. Symptoms can recur however in 25 to 33% of cases due to obstruction of the fenestration.
Material The authors describe the use of a valve for optic nerve sheath fenestration. The valve is made by introducing one end of a silicone tube between the two layers of arachnoid tissue overlying the optic nerve head and suturing the other end to the sclera. The latter tube end is obstructed except for two slits created laterally and has two small silicone wings used to anchor the sutures. When pressure inside the tube exceeds 10 mmHg, fluid spills through the two slit openings. This valve has been designed to improve the results of optic nerve sheath fenestration operations. Results Three patients underwent surgery using this technique. Visual acuity improved in one patient and visual loss did not progress in the two other patients.
Conclusion A theco-conjunctival shunt in the form of a valve to prevent obstruction of optic nerve sheath fenestration is an option that must be studied on a larger scale.