Herzau V, Baykal H E
Sektion für Motilitätsstörungen, Universitäts-Augenklinik Tübingen.
Klin Monbl Augenheilkd. 1998 Sep;213(3):154-60. doi: 10.1055/s-2008-1034966.
Chronic papilledema may lead to irreversible damage of optic nerve fibers. To preserve visual functions, a decompression of the optic nerve is recommended by means of a fenestration of the optic nerve sheath. In this study long-term results after optic nerve sheath fenestration in patients with idiopathic pseudotumor cerebri are reported.
14 patients were re-examined 15 to 145 months (mean 62 months) after a fenestration of the retrobulbar optic nerve sheath on 23 eyes by a transconjunctival approach. Surgery was done to treat progressive visual loss or in severe obscurations. The patient's symptoms, visual acuity, visual fields, and ophthalmoscopic findings of the optic nerve head and the central fundus were compared to the preoperative status.
Re-examination revealed improvement or stabilisation of objective and subjective findings in 17 eyes, one of them was operated on the more involved contralateral side only. Six eyes showed a recurrence of the papilledema without a functional change for the worse after an interval of 7 to 121 months. Three eyes of two patients ended up with optic atrophy and extensive visual loss. Preoperatively, these eyes had shown cotton wool spots in the optic nerve head and a rapid deterioration of vision.
Fenestration of the retrobulbar optic nerve sheath can prevent further visual loss in most patients with pseudotumor cerebri, unless the eye has already become nearly blind. Postoperatively, ophthalmological controls are necessary at regular intervals because relapses after successful surgery can occur after months or years.
慢性视乳头水肿可能导致视神经纤维的不可逆损伤。为保留视功能，建议通过视神经鞘开窗术对视神经进行减压。本研究报告了特发性假脑瘤患者视神经鞘开窗术后的长期结果。
14例患者在经结膜途径对23只眼进行球后视神经鞘开窗术后15至145个月（平均62个月）接受了复查。手术用于治疗进行性视力丧失或严重视物模糊。将患者的症状、视力、视野以及视神经乳头和眼底中央的检眼镜检查结果与术前状态进行比较。
复查显示17只眼中客观和主观检查结果有改善或稳定，其中1只眼仅对受累更严重的对侧进行了手术。6只眼在7至121个月的间隔后出现视乳头水肿复发，但功能未出现恶化改变。2例患者的3只眼最终出现视神经萎缩和严重视力丧失。术前，这些眼的视神经乳头有棉絮斑且视力迅速恶化。
球后视神经鞘开窗术可防止大多数假脑瘤患者进一步视力丧失，除非眼睛已几乎失明。术后，需要定期进行眼科检查，因为成功手术后数月或数年可能会出现复发。
