—We are grateful for the opportunity to respond to the interesting comments of Drs Mutlukan and Cullen. The modified decompression procedure with multiple linear openings in the dura and lyses of "adhesions" or "trabeculations" between the meninges and the optic nerve was described and illustrated in our series of patients undergoing this surgical procedure for chronic papilledema associated with pseudotumor cerebri.1 We are aware that the subdural space is only a potential space and that normal optic nerves demonstrate "adhesions." As we indicated in our reply to Dr Kellen, we should have specified the subarachnoid space rather than the subdural space as the source of the cerebrospinal fluid. However, with breakage of these "adhesions," we have consistently observed drainage of additional cerebrospinal fluid from areas of presumed entrapment.The possibility of an empty sella syndrome explaining the biliteral improvement experienced by two of our patients is an
Sergott RC, Cohen MS, Bosley TM, Savino PJ. Can Empty Sella Syndrome Be Mistaken for a Progressive Form of Nonarteritic Ischemic Optic Neuropathy?-Reply. Arch Ophthalmol. 1990;108(8):1067. doi:10.1001/archopht.1990.01070100022011
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