Corbett J J, Nerad J A, Tse D T, Anderson R L
Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City 52242.
Arch Ophthalmol. 1988 Oct;106(10):1391-7. doi: 10.1001/archopht.1988.01060140555022.
Twenty-eight patients with pseudotumor cerebri underwent 40 optic nerve sheath fenestrations for relief of visual loss or to preserve vision. Twenty women and eight men underwent 16 unilateral fenestrations and 12 bilateral operations. Papilledema disappeared or was strikingly reduced in 24 of 28 patients. The other four patients had gliotic discs (two patients) or were followed up for only a short time. Visual acuity improved in 12 of 40 eyes and remained the same in 22 of 40 eyes. Seventeen eyes had preoperative visual acuity of 20/30 or better. In six eyes visual acuity decreased. Of eight eyes operated on that had visual acuity of 20/200 or worse, only three showed improvement. Visual fields improved in 21 of 40 eyes and remained the same in ten eyes. Five of the ten eyes that did not change had poor vision before surgery. Eight eyes in five patients continued to lose acuity postoperatively. Each of these eight eyes had a concomitant loss of visual field. An additional two eyes developed visual field loss with preserved visual acuity. The indications for surgery are early evidence of progressive loss of visual field or acuity in a patient with pseudotumor cerebri. Severe vision loss presents little opportunity for improvement but fenestration may be used in a last effort to preserve or restore vision.
28例假性脑瘤患者接受了40次视神经鞘开窗术，以缓解视力丧失或保护视力。其中20名女性和8名男性接受了16次单侧开窗术和12次双侧手术。28例患者中有24例视乳头水肿消失或明显减轻。另外4例患者有视盘胶质增生（2例）或随访时间较短。40只眼中有12只视力提高，22只视力保持不变。17只眼术前视力为20/30或更好。6只眼视力下降。在接受手术的8只视力为20/200或更差的眼中，只有3只视力有所改善。40只眼中有21只视野改善，10只视野保持不变。视野未改变的10只眼中有5只术前视力较差。5例患者的8只眼术后视力继续下降。这8只眼中每只眼都伴有视野丧失。另外2只眼视力保持不变但出现了视野丧失。手术指征是假性脑瘤患者出现视野或视力进行性丧失的早期证据。严重视力丧失改善的机会很小，但开窗术可作为保护或恢复视力的最后手段。
