Modified optic nerve sheath decompression provides long-term visual improvement for pseudotumor cerebri
R. C. Sergott, P. J. Savino and T. M. Bosley
Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA 19107.
Twenty-three patients with chronic papilledema associated with pseudotumor
cerebri underwent "modified" optic nerve sheath decompression for treatment
of visual acuity and visual field loss. Instead of removing a single,
rectangular section of optic nerve meninges, the operation was modified by
making at least three longitudinal incisions in the sheath and then lysing
arachnoid adhesions with a tenotomy hook. Twenty-one of the 23 patients
demonstrated improved visual function after the initial surgery for a mean
(+/- SD) follow-up of 21.5 +/- 12.3 months (median, 25 months; range, three
to 45 months) without reoperation or reinstitution or oral corticosteroid
and diuretic therapies. The two patients failing to improve after the first
surgical procedure initially had a single meningeal window created and
subsequently improved following reoperation with the modified procedure.
Twelve of 21 patients with bilateral visual loss had improved visual
function bilaterally after unilateral surgery. Six of the 21 patients
needed bilateral surgery, and the other three had minor visual field
defects in the second eye not severe enough to warrant surgery.
Preoperative optic disc pallor did not predict a poor postoperative result.
Optic nerve surgery improved the visual function in six patients who had
failed to recover vision after one or more lumbar-peritoneal shunts.
