Optic nerve sheath fenestration in pseudotumor cerebri. A lateral orbitotomy approach
D. T. Tse, J. A. Nerad, R. L. Anderson and J. J. Corbett
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL 33101.
In patients with pseudotumor cerebri accompanied by loss of vision, optic
nerve sheath fenestration is an effective route to prompt recovery of
vision. A lateral orbitotomy approach to decompression of the optic nerve
is appropriate for the ophthalmologist with adequate orbital experience. A
rectangular window of dura and arachnoid, measuring approximately 3 X 5 mm,
is excised from the bulbous portion of the optic nerve. It is important
that the arachnoid within the window is excised because an intact arachnoid
is an effective barrier to cerebrospinal fluid egress. The use of operating
microscope, microsurgical instrument, and microdissecting techniques are
emphasized. Twenty-eight patients (40 eyes) with progressive visual loss
were treated by surgical nerve sheath fenestration. A study of the
indications, results, and complications of this procedure is presented in a
companion article.
