title: Visual outcomes of surgical intervention for pseudotumour cerebri: optic nerve sheath fenestration versus cerebrospinal fluid diversion.
abstract: OBJECTIVE
  To compare visual outcomes in pseudotumour cerebri (PTC) patients who underwent either optic nerve sheath fenestration (ONSF) or cerebrospinal fluid (CSF) diversion (shunt) for treatment of visual loss from papilloedema.
  
  
  METHODS
  Comparative case series of thirty-three patients (33 eyes) who underwent either ONSF (14 patients) or CSF shunt (19 patients) for papilloedema and vision loss. Preoperative and final postoperative visual acuity and mean deviation (MD) on automated perimetry were assessed in addition to papilloedema severity and resolution. Mann-Whitney U test was employed to evaluate differences in final visual outcomes.
  
  
  RESULTS
  Postoperative visual acuity did not differ between ONSF (76.4 ETDRS equivalent letters) and shunt (76.4 letters), although there was a trend toward worse preoperative acuity in the ONSF cohort. Final MD was significantly better after shunt (-9.23 dB) compared to ONSF (-17.29 dB), U=52.0, p=0.036. Preoperative papilloedema was qualitatively worse in the ONSF group.
  
  
  CONCLUSIONS
  Visual acuity and MD improved after ONSF and shunt procedures in patients with severe vision loss from PTC and papilloedema. Improvement of MD in both groups was of the same magnitude (6 dB), but because the two groups were not entirely comparable, prospective comparison of the two procedures is required to establish the relative efficacy of each procedure.
authors.affiliation: Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Fonseca
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
authors.affiliation: Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Miller
authors.affiliation: Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Prem S
authors.initials: PS
authors.lastname: Subramanian
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009900:Optic Nerve / Q000503:physiopathology / Q000601:surgery*; D010211:Papilledema / Q000503:physiopathology / Q000601:surgery*; D011559:Pseudotumor Cerebri / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt; D014792:Visual Acuity / Q000502:physiology*; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology; D055815:Young Adult
keywords: Field of vision; Optic Nerve; Treatment Surgery