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OPHTHALMOLOGY PRACTICE
Year : 2014  |  Volume : 62  |  Issue : 10  |  Page : 1015-1021

Controversies: Optic nerve sheath fenestration versus shunt placement for the treatment of idiopathic intracranial hypertension


1 Department of Ophthalmology, Houston Methodist Hospital, Houston, USA
2 Department of Ophthalmology, Baylor College of Medicine, Houston, USA
3 Department of Ophthalmology, Houston Methodist Hospital; Department of Ophthalmology, Baylor College of Medicine, Houston; Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, TX, USA

Correspondence Address:
Andrew G Lee
Department of Ophthalmology, Houston Methodist Hospital, 6560 Fannin Street, Scurlock Tower 450, Houston, Tx 77030
USA
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Source of Support: This work was supported in part by an unrestricted grant from Research to Prevent Blindness (RPB) to the University of Texas Medical Branch, Galveston, Texas, USA, Conflict of Interest: None


DOI: 10.4103/0301-4738.146012

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Background: Idiopathic intracranial hypertension (IIH) has been increasing in prevalence in the past decade, following the obesity epidemic. When medical treatment fails, surgical treatment options must be considered. However, controversy remains as to which surgical procedure is the preferred surgical option - optic nerve sheath fenestration (ONSF) or cerebrospinal fluid (CSF) shunting - for the long-term treatment of this syndrome. Purpose: To provide a clinical update of the pros and cons of ONSF versus shunt placement for the treatment of IIH. Design: This was a retrospective review of the current literature in the English language indexed in PubMed. Methods: The authors conducted a PubMed search using the following terms: Idiopathic IIH, pseudotumor cerebri, ONSF, CSF shunts, vetriculo-peritoneal shunting, and lumbo-peritoneal shunting. The authors included pertinent and significant original articles, review articles, and case reports, which revealed the new aspects and updates in these topics. Results: The treatment of IIH remains controversial and lacks randomized controlled clinical trial data. Treatment of IIH rests with the determination of the severity of IIH-related visual loss and headache. Conclusion: The decision for ONSF versus shunting is somewhat institution and surgeon dependent. ONSF is preferred for patients with visual symptoms whereas shunting is reserved for patients with headache. There are positive and negative aspects of both procedures, and a prospective, randomized, controlled trial is needed (currently underway). This article will hopefully be helpful in allowing the reader to make a more informed decision until that time.


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