Unilateral endoscopic optic nerve decompression for idiopathic intracranial hypertension: a series of 10 patients.
OBJECTIVE
Several surgical treatment modalities, including lumboperitoneal or ventriculoperitoneal shunt surgery, subtemporal decompression, endovascular venous sinus stenting, optic nerve decompression (OND), were used in the management of idiopathic intracranial hypertension (IIH). Each surgical technique has different advantages and disadvantages. Endoscopic OND is rarely used in the management of IIH. There are only four reported cases. The aim of this study is to describe the surgical results of patients treated with this less invasive surgical technique.


METHODS
A series of 10 consecutive cases of unilateral OND was reviewed. Between December 2008 and December 2012 these patients underwent the endoscopic approach without nerve sheath opening. Presenting symptoms, neurological examination findings, magnetic resonance venography imaging results, fundoscopic and visual acuity examination findings, and automated perimetry test results were recorded. Perioperative results, including complications and length of hospital stay, were evaluated. Findings at follow-up evaluations were also recorded.


RESULTS
This report is the first series of unilateral OND performed using the endoscopic approach. The mean patient age was 34.1 years (range, 9-49 years); there were nine female and one male patients. Visual impairment was the main symptom in this patient group, whereas headache was a secondary complaint. The patients were first managed with medical treatment for at least 3 months. Unilateral endoscopic OND was performed on the side with the most visual failure. Mean follow-up was 28.4 months (range, 8-55 months). The visual field defects and visual acuity improved in eight of nine patients, whereas papilloedema improved in seven of nine patients. Also headaches resolved in four of seven patients. There were no complications in this relatively small series.


CONCLUSIONS
The surgical treatment of IIH by using the unilateral endoscopic OND technique is a safe and effective method in the hands of experienced surgeons with advanced endoscopic skills. A collaboration with the ophthalmology team is needed for the follow-up. Further studies with larger patient numbers is needed to compare unilateral endoscopic OND technique with the current techniques used in the surgical management of IIH.
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Altay
A
Sencer
Department of Neurosurgery, Taksim Training and Research Hospital, Istanbul, Turkey. Electronic address: moakcakaya@gmail.com.
Mehmet Osman
MO
Akcakaya
Department of Otorhinolaryngology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Bora
B
Basaran
Department of Neurosurgery, Artvin State Hospital, Artvin, Turkey.
Ali Guven
AG
Yorukoglu
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Aydin
A
Aydoseli
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Yavuz
Y
Aras
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Fahir
F
Sencan
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey; Department of Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
Banu
B
Satana
Department of Otorhinolaryngology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Ismet
I
Aslan
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Omer Faruk
OF
Unal
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Nail
N
Izgi
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Ali
A
Canbolat
D000293:Adolescent; D000328:Adult; D002648:Child; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009408:Nerve Compression Syndromes / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods*; D009900:Optic Nerve / Q000601:surgery*; D011559:Pseudotumor Cerebri / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity; D058609:Visual Field Tests; D055815:Young Adult
Decompression; Endoscopic; Idiopathic intracranial hypertension; Minimal invasive; Optic nerve; Pseudotumor cerebri; Surgical