Optic nerve sheath decompression for pseudotumor cerebri
N. D. Brourman, T. C. Spoor and J. M. Ramocki
Kresge Eye Institute, Detroit, MI 48201.
We studied optic nerve sheath decompressions for pseudotumor cerebri
performed at the Kresge Eye Institute, Detroit, over the past year. Six
patients (ten eyes) were operated on. Visual function improved in all ten
eyes. A decision to operate was based on progressive loss of visual acuity
or visual field unresponsive to medical therapy, accompanied by echographic
evidence of a distended optic nerve sheath (positive 30 degrees test).
Follow-up ranged from four to 11 months. Four patients underwent
subarachnoid iopamidol (Isovue) contrast injection followed by orbital
computed tomography. The subarachnoid space totally filled in all patients.
No evidence of fibrosis or obstruction of the optic nerve sheath existed;
however, leakage of dye from the optic nerve sheath could not be
demonstrated. Postoperative complications included transient diplopia and
transient atonic pupil (one patient each). Our results indicate that optic
nerve sheath decompression improves and protects visual function in
patients with pseudotumor cerebri who demonstrate progressive visual field
loss and fluid in the optic nerve sheath.
