Introduction: Several surgical treatment modalities, including shunt surgery, subtemporal decompression, and optic nerve decompression (OND) have been used in the management of idiopathic intracranial hypertension (IIH). Endoscopic OND was first used in traumatic optic neuropathy and positive results were achieved. The aim of this study is to describe a less invasive surgical procedure and present its effectiveness.
Methods: We reviewed a series of eight consecutive cases of IIH on which unilateral OND performed, using the endoscopic approach without nerve sheath fenestration between December 2008 and December 2011. Presenting symptoms, neurological examination findings, MR venography imaging, VAS scores for headache, fundoscopic and visual acuity examination findings and automated perimetry test results were recorded. Perioperative results, including complications, length of hospital stay were evaluated. Findings at the follow-up evaluations were also recorded.
Results: Although seems small, this is actually the largest series of unilateral OND performed using transnasal endoscopic approach without optic sheath fenestration. The mean patient age was 31 years (range 9-46), there were 7 female and 1 male patients. Visual impairment was the main symptom in our patient group, whereas headache was a secondary complaint in all. The patients were first managed with medical treatment for at least 3 months. Unilateral endoscopic OND was performed on the side with greater visual failure. Mean follow-up was 17 months (range 3-39). The visual field, visual acuity and papilledema improved in all patients. Also headache was partially resolved in all patients. There were no surgical complications in this relatively small series.
Conclusions: The surgical treatment of IIH by using unilateral transnasal endoscopic OND without optic sheath fenestration is a safe and effective method in the hands of experienced surgeons with basic endoscopic skills. A further study with larger patient numbers is needed to compare this technique with current techniques used in the surgical management of IIH.
Patient Care: With the help of further studies patients hopefully will be able to be managed with a lesser invasive surgical procedure.
Learning Objectives: By the conclusion of this session, participants should be aware of a less invasive technique in the surgical treatment of IIH.