Department of Neurosurgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA.
Department of Otolaryngology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA.
Clin Neurol Neurosurg. 2023 Jun;229:107750. doi: 10.1016/j.clineuro.2023.107750. Epub 2023 Apr 30.
The neurosurgical management of idiopathic intracranial hypertension (IIH) remains controversial. Although shunting and newer endovascular stenting techniques are part of the neurosurgical armamentarium to treat medically refractory IIH symptoms, optic nerve sheath fenestration has traditionally been performed by ophthalmologists.
We present a detailed cadaveric dissection that simulates the endoscopic endonasal optic nerve sheath decompression (EONSD) technique along with the literature review.
EONSD was performed in four freshly injected cadaveric specimens. Additionally, a systematic review from different electronic databases has been done.
Bilateral EONSD was performed in all specimens without significant technical difficulties. Based on our experience, there is no need to expose the periorbita or orbital apex. The primary anatomic landmarks were the optic canal, the lateral opticocarotid recess, the tuberculum, the limbus, and the clinoid segment of the internal carotid artery. Based on the systematic review, 68 patients (77.9% female) underwent EONSD, with a mean age of 33.4 ± 6.9 years in adult patients. Follow-up ranged from 3 to 58 months across different studies. The pooled meta-analysis showed headache, papilledema, and visual disturbance improvement in 78% [95%CI 0.65-0.90], 72% [95%CI 0.61-0.83], and 88% [95%CI 0.80-0.96] of cases who underwent EONSD, respectively. The subgroup analysis showed there was no statistically significant difference between unilateral and bilateral EONSD in terms of different measured outcomes.
EONSD is a feasible surgical procedure that may obviate the need for shunting in patients with IIH. Although clinical studies showed that EONSD is a safe and effective technique, further studies are required to establish the preferences of either unilateral or bilateral approaches.
特发性颅内高压（IIH）的神经外科治疗仍然存在争议。尽管分流和更新的血管内支架技术是治疗药物难治性 IIH 症状的神经外科手段的一部分，但视神经鞘开窗术传统上是由眼科医生进行的。
我们展示了一项详细的尸体解剖，模拟了经鼻内镜视神经鞘减压术（EONSD）技术，并进行了文献回顾。
在四个新鲜注射的尸体标本中进行了 EONSD。此外，还对不同的电子数据库进行了系统回顾。
所有标本均成功进行了双侧 EONSD，没有明显的技术困难。根据我们的经验，没有必要暴露眼外肌或眶尖。主要的解剖标志是视神经管、外侧视神经-颈动脉隐窝、结节、角膜缘和颈内动脉的床突段。根据系统回顾，68 例（77.9%女性）患者接受了 EONSD，成人患者的平均年龄为 33.4±6.9 岁。不同研究的随访时间从 3 到 58 个月不等。汇总的荟萃分析显示，78%（95%CI 0.65-0.90）、72%（95%CI 0.61-0.83）和 88%（95%CI 0.80-0.96）的患者在接受 EONSD 后头痛、视乳头水肿和视力障碍得到改善。亚组分析显示，在不同的测量结果方面，单侧和双侧 EONSD 之间没有统计学上的显著差异。
EONSD 是一种可行的手术方法，可能使 IIH 患者无需分流。尽管临床研究表明 EONSD 是一种安全有效的技术，但需要进一步的研究来确定单侧或双侧方法的偏好。
