Results of optic nerve sheath fenestration for pseudotumor cerebri. The lateral orbitotomy approach
J. J. Corbett, J. A. Nerad, D. T. Tse and R. L. Anderson
Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City 52242.
Twenty-eight patients with pseudotumor cerebri underwent 40 optic nerve
sheath fenestrations for relief of visual loss or to preserve vision.
Twenty women and eight men underwent 16 unilateral fenestrations and 12
bilateral operations. Papilledema disappeared or was strikingly reduced in
24 of 28 patients. The other four patients had gliotic discs (two patients)
or were followed up for only a short time. Visual acuity improved in 12 of
40 eyes and remained the same in 22 of 40 eyes. Seventeen eyes had
preoperative visual acuity of 20/30 or better. In six eyes visual acuity
decreased. Of eight eyes operated on that had visual acuity of 20/200 or
worse, only three showed improvement. Visual fields improved in 21 of 40
eyes and remained the same in ten eyes. Five of the ten eyes that did not
change had poor vision before surgery. Eight eyes in five patients
continued to lose acuity postoperatively. Each of these eight eyes had a
concomitant loss of visual field. An additional two eyes developed visual
field loss with preserved visual acuity. The indications for surgery are
early evidence of progressive loss of visual field or acuity in a patient
with pseudotumor cerebri. Severe vision loss presents little opportunity
for improvement but fenestration may be used in a last effort to preserve
or restore vision.
