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A Clinical Pathologic Study

John L. Keltner, MD; Daniel M. Albert, MD; Martin Lubow, MD; Esther Fritsch, MD; Lycurgus M. Davey, MD

Arch Ophthalmol. 1977;95(1):97-104.

Abstract
• Decompression of the perioptic meninges for intractable chronic papilledema was done in a patient with a right parietal temporal glioblastoma multiforme. The patient died 39 days postoperatively. Histologic study of the optic nerves indicated fistulas in the dura compatible with cerebrospinal fluid (CSF) egress and maintenance of a normal subarachnoid space around the nerve. Two additional patients with unilateral optic nerve decompression producing bilateral resolution of papilledema were studied. We contend that egress of CSF was the principle mode of action in these three cases. How long the dural fistula remains patent is unknown. Reports in the literature show considerable variation in the effects of optic nerve decompression. Anatomic variation of the intracanalicular subarachnoid space together with differences in underlying pathologic condition, surgical technique, and patient response may explain discrepancies among the results reported.

(Arch Ophthalmol 95:97-104, 1977)

Author Affiliations
From the Departments of Ophthalmology, Neurology, and Neurological Surgery, University of California, Davis School of Medicine (Dr Keltner); Howe Laboratory of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Cambridge (Dr Albert); Ohio State University Hospitals, Columbus (Dr Lubow); and the Departments of Ophthalmology and Visual Science (Dr Fritch) and Neuro-Surgery (Dr Davey), Yale University School of Medicine.

Footnotes
Accepted for publication July 6, 1976.

Read in part before the Eighth Annual Neuro-Ophthalmic Pathology Symposium, Scheie Eye Institute, Presbyterian-University of Pennsylvania Medical Center, Philadelphia, Feb 20, 1976.

Reprint requests to Department of Ophthalmology, University of California School of Medicine, Davis, UCD Professional Building, Room 251, 4301 X St, Sacramento, CA 95817 (Dr Keltner).

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