Update on the application of optic nerve sheath fenestration.
With the ongoing development of surgical procedures and instruments, the safety of optic nerve sheath fenestration (ONSF) has been improved.



Through the past three decades, progress has been made in preventing visual loss from chronic optic nerve swelling in idiopathic intracranial hypertension (IIH), secondary intracranial hypertension and local optic nerve diseases. We now review the updated application of ONSF in those diseases.



The application of ONSF in papilledema due to IIH, secondary intracranial hypertension to cerebral venous sinus occlusion, Cryptococcal meningitis, and intracranial mass or tumors is reviewed. Additionally, the potential benefits of ONSF in local optic neuropathy from optic nerve sheath meningioma, optic nerve drusen, traumatic optic neuropathy and optic nerve/sheath biopsy are also described.



Although ONSF has little or no effect on intracranial pressure, it is a safe, relative easy and effective surgical procedure to prevent or reverse visual loss in IIH. When other treatment modalities fail to timely protect vision, ONSF can be useful in protecting visual function or delay visual loss in secondary intracranial hypertension.



We recommend that ONSF should be considered as a meaningful alternative or an adjunct therapy to reduce or delay the visual morbidity of these diseases, although the use of ONSF for some of them remains controversial.
Department of Ophthalmology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China.|Laboratory Animal Institute, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China.
Hui
H
Chen
Department of Ophthalmology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China.
Qian
Q
Zhang
Department of Neurology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China.
Song
S
Tan
Institute for Infocomm Research, Agency for Science, Technology and Research (A*STAR), Singapore.
Huazhu
H
Fu
Department of Ophthalmology, University of Oklahoma School of Medicine, Oklahoma City, OK, USA.|Department of Ophthalmology, Dean A. McGee Eye Institute, University of Oklahoma School of Medicine, Oklahoma City, OK, USA.
Bradley K
BK
Farris
Sichuan Provincial Key Laboratory for Disease Gene Study, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China.
Zhenglin
Z
Yang
D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D009901:Optic Nerve Diseases / Q000209:etiology / Q000601:surgery*
Optic nerve sheath fenestration (ONSF); idiopathic intracranial hypertension (IIH); optic neuropathy; secondary intracranial hypertension