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Arquivos Brasileiros de Oftalmologia
On-line version ISSN 1678-2925
MONTEIRO, Mário Luiz Ribeiro. Optic nerve sheath decompression for the treatment of papilledema in pseudotumor cerebri. Arq. Bras. Oftalmol. [online]. 2002, vol.65, n.4, pp. 401-407. ISSN 1678-2925. http://dx.doi.org/10.1590/S0004-27492002000400002.
Purpose: To evaluate the efficacy of optic nerve sheath decompression (ONSD) performed in eyes with papilledema and visual loss in patients with pseudotumor cerebri. Methods: Seventeen patients (24 eyes) submitted to optic nerve sheath decompression from January 1991 until January 1999 were analyzed. All of them had the diagnosis of pseudotumor cerebri and were operated on due to reduction of visual acuity (VA) and/or visual fields (VF). Two patients did not tolerate clinical treatment with diuretics and corticosteroids and the others did not present a satisfactory response to these treatments. Four patients had been previously submitted to lumboperitoneal shunt. Results: Surgery was unilateral in 10 patients and bilateral in 7. Four patients were submitted to bilateral simultaneous surgery because of the severity of visual loss. Visual acuity and/or visual fields improved in 14 eyes, remained unchanged in 9 and became worse in one of 24 operated eyes. The patient that worsened already had rapidly progressive severe visual loss with a remaining paracentral island of vision and visual acuity of counting finger in the preoperative period. Papilledema resolved in every operated eye, followed by optic atrophy in many of them. Patients who did not improve vision were those who already had severe visual loss at the time of surgery. Moderate intraoperative hemorrhage occurred in two surgeries. Conclusions: Optic nerve sheath decompression can be useful to protect visual function in patients with papilledema from pseudotumor cerebri who do not respond properly to clinical treatment. It can also be helpful as an adjunctive treatment in patients with lumboperitoneal shunt surgery.
Keywords : Papilledema; Pseudotumor cerebri [surgery]; Pseudotumor cerebri [complications]; Pseudotumor cerebri [drug therapy]; Surgical decompression; Optic nerve [surgery]; Visual acuity; Visual fields.