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Lyson T, Sieskiewicz A, Chrzanowski R, Konopinska J, Rogowski M, Mariak Z. Endoscopic transconjunctival optic nerve sheath fenestration for progressive idiopathic visual field deficit: a case report. J Int Med Res 2021; 49:3000605211048362. [PMID: 34693780 PMCID: PMC8638564 DOI: 10.1177/03000605211048362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intra-orbital optic nerve sheath fenestration (ONSF) is an effective option in patients with progressive vision loss due to idiopathic intracranial hypertension. Most proposed techniques involve surgical trauma and require disinsertion of the medial rectus muscle; thus, less invasive surgical procedures are needed. Here, a feasible and effective technique of endoscopic intra-orbital ONSF through a conjunctival incision is presented, in a patient with a progressively compromised visual field, papilloedema, and distended subarachnoid space around the optic nerves. The retrobulbar segment of the optic nerve was exposed for incision, avoiding manipulation of the lateral orbital rim bones and irritation of the ciliary microvessels and nerves. The patient regained the entire visual field. ONSF was safely and effectively performed endoscopically through a narrow corridor gained by brushing away the orbital fat with minimal traction on the medial rectus muscle. The small postoperative wound was associated with faster and easier convalescence, and less tissue trauma versus conventional open approaches.
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Affiliation(s)
- Tomasz Lyson
- Department of Neurosurgery, Medical University of Białystok, Białystok, Poland
| | - Andrzej Sieskiewicz
- Department of Otolaryngology, Medical University of Białystok, Białystok, Poland
| | - Robert Chrzanowski
- Department of Neurosurgery, Medical University of Białystok, Białystok, Poland
| | - Joanna Konopinska
- Department of Ophthalmology, Medical University of Białystok, Białystok, Poland
| | - Marek Rogowski
- Department of Otolaryngology, Medical University of Białystok, Białystok, Poland
| | - Zenon Mariak
- Department of Neurosurgery, Medical University of Białystok, Białystok, Poland
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Kalyvas A, Neromyliotis E, Koutsarnakis C, Komaitis S, Drosos E, Skandalakis GP, Pantazi M, Gobin YP, Stranjalis G, Patsalides A. A systematic review of surgical treatments of idiopathic intracranial hypertension (IIH). Neurosurg Rev 2020; 44:773-792. [PMID: 32335853 DOI: 10.1007/s10143-020-01288-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 01/28/2023]
Abstract
Idiopathic intracranial hypertension denotes raised intracranial pressure in the absence of an identifiable cause and presents with symptoms relating to elevated ICP, namely headaches and visual deterioration. Treatment of IIH aims at reducing intracranial pressure, relieving headache and salvaging patients' vision. Surgical interventions are recommended for medically refractory IIH and include CSF diversion techniques, optic nerve sheath fenestration, bariatric surgery and venous sinus stenting. Prospective studies on the surgical options for IIH are scant and no evidence-based guidelines for the surgical management of medically refractory IIH have been established. A search in Cochrane Library, MEDLINE and EMBASE from 1 January 1985 to 19 April 2019 for controlled or observational studies on the surgical treatment of IIH (defined in accordance with the modified Dandy or the modified Friedman criteria) in adults yielded 109 admissible studies. VSS improved papilledema, visual fields and headaches in 87.1%, 72.7% and 72.1% of the patients respectively, with a 2.3% severe complication rate and 11.3% failure rate. CSF diversion techniques diminished papilledema, visual field deterioration and headaches in 78.9%, 66.8% and 69.8% of the cases and are associated with a 9.4 severe complication rate and a 43.4% failure rate. ONSF ameliorated papilledema, visual field defects and headaches in 90.5, 65.2% and 49.3% of patients. Severe complication rate was 2.2% and failure rate was 9.4%. This is currently the largest systematic review for the available operative modalities for IIH. VSS provided the best results in headache resolution and visual outcomes, with low failure rates and a very favourable complication profile. In light of this, VSS ought to be regarded as the first-line surgical modality for the treatment of medically refractory IIH.
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Affiliation(s)
- Aristotelis Kalyvas
- Division of Neurosurgery, Toronto Western Hospital/University Health Network, University of Toronto, Toronto, ON, Canada. .,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Eleftherios Neromyliotis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Koutsarnakis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Komaitis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Drosos
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios P Skandalakis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mantha Pantazi
- Department of Pediatrics, Hatzikosta General Hospital, Ioannina, Greece
| | - Y Pierre Gobin
- Department of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - George Stranjalis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Center for Neurosurgical Research, "Petros Kokkalis", Athens, Greece
| | - A Patsalides
- Department of Neurological Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
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Chatziralli I, Theodossiadis P, Theodossiadis G, Asproudis I. Perspectives on diagnosis and management of adult idiopathic intracranial hypertension. Graefes Arch Clin Exp Ophthalmol 2018; 256:1217-1224. [PMID: 29619550 DOI: 10.1007/s00417-018-3970-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/19/2018] [Accepted: 03/26/2018] [Indexed: 01/03/2023] Open
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Current concepts and strategies in the diagnosis and management of idiopathic intracranial hypertension in adults. J Neurol 2017; 264:1622-1633. [DOI: 10.1007/s00415-017-8401-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
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