title: Outcomes of endoscopic optic nerve decompression in patients with idiopathic intracranial hypertension.
abstract: The conventional treatment for idiopathic intracranial hypertension involves weight loss, steroids, diuretics, and/or serial lumbar punctures; however, if the symptoms persist or worsen, surgical intervention is recommended. Surgical options include cerebrospinal fluid diversion procedures, such as ventriculoperitoneal and lumboperitoneal shunts, and optic nerve decompression with nerve sheath fenestration. The latter can be carried out using an endoscopic approach, but the outcomes of this technique have not been firmly established.
  
  
  
  This systematic review examined the outcomes of performing endoscopic optic nerve decompression (EOND) in patients with idiopathic intracranial hypertension (IIH). Six studies were included for a total of 34 patients.
  
  
  
  The patients presented with visual field disturbances (32 of 32 [100%]), visual acuity disruptions (33 of 34 [97.1%]), papilledema (26 of 34 [76.5%]), and persistent headache (30 of 33 [90.1%]). The mean duration of symptoms ranged from 7 to 32 months. Overall, the patients showed post-EOND improvement in signs and symptoms associated with IIH, specifically visual field deficits (93.8%), visual acuity (85.3%), papilledema (81.4%), and headaches (81.8%). Interestingly, 11 cases showed postoperative improvement in their symptoms with bony decompression of the optic canal alone, without nerve sheath fenestration. There were no major adverse events or complications reported with this approach.
  
  
  
  EOND appears to be a promising and safe surgical alternative for patients with IIH who fail to respond to medical treatment. Further studies are needed before we can attest to the clinical validity of this procedure.
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Luisam
authors.initials: L
authors.lastname: Tarrats
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Hernández
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: José M
authors.initials: JM
authors.lastname: Busquets
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Portela
authors.affiliation: Department of Ophthalmology, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Serrano
authors.affiliation: Puerto Rico Clinical and Translational Research Consortium, San Juan, Puerto Rico.
authors.forename: Lorena
authors.initials: L
authors.lastname: González-Sepúlveda
authors.affiliation: Department of Otolaryngology Head & Neck Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: José R
authors.initials: JR
authors.lastname: Sánchez-Pérez
mesh_terms: D019299:Decompression, Surgical; D004724:Endoscopy; D006801:Humans; D009900:Optic Nerve / Q000601:surgery*; D011559:Pseudotumor Cerebri / Q000601:surgery*; D016896:Treatment Outcome
keywords: endoscopic optic nerve decompression; idiopathic intracranial hypertension; nerve sheath fenestration; papilledema; pseudotumor cerebri