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October 1988

Optic Nerve Sheath Fenestration in Pseudotumor CerebriA Lateral Orbitotomy Approach

Author Affiliations

From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine (Dr Tse); the Oculoplastic, Orbital, and Oncology Service, University of Iowa Hospitals and Clinics, Iowa City (Dr Nerad); the Department of Ophthalmology, University of Utah, Salt Lake City (Dr Anderson); and the Department of Neurology, University of Iowa, Iowa City (Dr Corbett).

Arch Ophthalmol. 1988;106(10):1458-1462. doi:10.1001/archopht.1988.01060140622035

• In patients with pseudotumor cerebri accompanied by loss of vision, optic nerve sheath fenestration is an effective route to prompt recovery of vision. A lateral orbitotomy approach to decompression of the optic nerve is appropriate for the ophthalmologist with adequate orbital experience. A rectangular window of dura and arachnoid, measuring approximately 3 × 5 mm, is excised from the bulbous portion of the optic nerve. It is important that the arachnoid within the window is excised because an intact arachnoid is an effective barrier to cerebrospinal fluid egress. The use of operating microscope, microsurgical instrument, and microdissecting techniques are emphasized. Twenty-eight patients (40 eyes) with progressive visual loss were treated by surgical nerve sheath fenestration. A study of the indications, results, and complications of this procedure is presented in a companion article.