Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Neuro-otology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Neurol India. 2020 Jan-Feb;68(1):54-60. doi: 10.4103/0028-3886.279701.
Progressive vision loss is a dismal sequelae of idiopathic intracranial hypertension (IIH) and secondary intracranial hypertension with cerebro-venous sinus thrombosis (CVST). The initial management revolves around weight loss, acetazolamide, steroids, and diuretics. A subset of unfortunate patients, refractory to medical therapy, need surgical intervention in the form of CSF diversion or optic nerve decompression (OND). The ONDd is an emerging alternative with encouraging early results.
In our study, we share our experience of ONDd by endoscopic endonasal corridor, highlighting the technical nuances of procedure and discuss the indications of the same in the era of advanced technology.
A retrospective, noncomparative review of the medical records of all the patients of IIH (ICHD-III criteria) with severe vision loss, refractory to medical treatment, and with established objective evidence of papilledema was done. All the patients were operated in our department by endoscopic endonasal sheath fenestration.
Nine patients (M:F 3:6) underwent endoscopic endonasal optic nerve decompression (2016-2019) approach for medically refractive IIH (n = 6) and CVST (n = 3). The mean age of population was 21.44 ± 5.14 years; 6 patients had improvement in headache and 6 had improvement in visual acuity. The visual acuity deteriorated in two patients (n = 1 IIH and n = 1 CVST with dural AVF). One patient needed postoperative lumbar drain for CSF leak, while none had meningitis.
Endoscopic optic nerve sheath fenestration is minimally invasive and effective alternative with promising outcome in the management of medical refractory IIH or CVST.
特发性颅内高压（IIH）和继发于颅内静脉窦血栓形成（CVST）的颅内高压引起的进行性视力丧失是一种令人沮丧的后遗症。初始治疗围绕着减肥、乙酰唑胺、类固醇和利尿剂。一小部分不幸的患者对药物治疗有抗药性，需要手术干预，形式为脑脊液分流或视神经减压（OND）。ONDd 是一种新兴的替代方法，早期结果令人鼓舞。
在我们的研究中，我们通过经鼻内镜入路分享 ONDd 的经验，强调了该手术的技术细节，并讨论了在先进技术时代的适应证。
回顾性分析了所有患有严重视力丧失、对药物治疗有抗药性且有明确的视乳头水肿客观证据的 IIH（ICHD-III 标准）患者的病历。所有患者均在我科通过经鼻内镜鞘窗视神经减压术（2016-2019 年）进行手术。
9 例（男：女 3:6）因药物难治性 IIH（n=6）和 CVST（n=3）而行内镜下经鼻视神经减压术。患者的平均年龄为 21.44±5.14 岁；6 例头痛缓解，6 例视力改善。2 例患者视力恶化（n=1 IIH，n=1 CVST 合并硬脑膜动静脉瘘）。1 例患者术后因脑脊液漏需行腰椎引流，无脑膜炎发生。
内镜视神经鞘开窗术是一种微创、有效的治疗方法，对药物难治性 IIH 或 CVST 的治疗具有良好的效果。
