Fenestration of optic nerve sheaths in pseudotumor cerebri

Abstract

In 15 out of 50 patients with pseudotumor cerebri a fenestration of the retrobulbar optic nerve dural sheath was carried out in order to prevent functional damage due to papilledema. Full and permanent regression of the papilledema resulted in 24 out of 27 eyes without reduction of the elevated CSF pressure. Functionally, the obscurations disappeared on the operated side. Visual acuity and visual fields showed in most cases no change or only a slight improvement. In three eyes with ischemic papilledema the advanced visual loss was even accelerated.

Optic nerve sheath fenestration in pseudotumor cerebri seems to be a safe procedure in cases of imminent or beginning visual loss, but not in advanced axonal damage with ischemic signs of papilledema.

Key Words:

• pseudotumor cerebri
• surgical therapy
• optic nerve decompression
• postoperative complications