Optic Nerve Sheath Decompression in Idiopathic Intracranial Hypertension: A Case Report


  • Osman Korucu Department of Neurology, Keçiören Training and Research Hospital, Ankara, Turkey
  • Arif Ülkü Yener Department of Ophthalmology, Keçiören Training and Research Hospital, Ankara, Turkey


Idiopathic Intracranial Hypertension, Optic Nerve Sheath Decompression


Idiopathic intracranial hypertension(IHH) is an uncommon disorder characterized by increased intracranial pressure without radiological or laboratory evidence of intracranial pathology. It occurs most commonly in young, obese women, in their third and fourth decades. In this case, visual field test results of a 31-year-old woman with IIH are reported. This patient with amblyopia in her left eye, was treated medically with acetazolamide after being diagnosed with IIH and underwent optic nerve sheath decompression surgery after 8 years.


Durcan FJ, Corbett JJ,Wall M. The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana. Arch Neurol. 1988;45:875-877. https://doi.org/10.1001/archneur.1988.00520320065016

Wall M. The headache profile of idiopathic intracranial hypertension. Cephalalgia. 1990;10:331 -335.https://doi.org/10.1046/j.1468-2982.1990.1006331.x

Wall M. Idiopathic intracranial hypertension. NeurolClin. 2010;28:593-617.https://doi.org/10.1016/j.ncl.2010.03.003

Julayanont P, Karukote A, Ruthirago D, et al. Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects. J Pain Res. 2016:9:87-99. https://doi.org/10.2147/jpr.s60633

Wall M, Kupersmith MJ, Kieburtz KD, et al. The idiopathic intracranial hypertension treatmenttrial: clinical profile at baseline. JAMA Neurol. 2014;71:693-701.https://doi.org/10.1001/jamaneurol.2014.133

Jindal M, Hiam L, Raman A, et al. Idiopathic intracranial hypertension in otolaryngology. Eur Arch Otorhinolaryngol. 2009;266:803-806. https://doi.org/10.1007/s00405-009-0973-0

Sismanis A, Callari RH, Slomka WS, et al. Auditory-evoked responses in benign intracranial Hypertension syndrome. Laryngoscope. 1990;100:1152-1155. https://doi.org/10.1288/00005537-199011000-00003

Yri HM, Fagerlund B, Forchhammer HB, et al.. Cognitive function in idiopathic intracranial hypertension: a prospective case-control study. BMJ Open. 2014 Apr 8;4(4):e004376.https://doi.org/10.1136/bmjopen-2013-004376

Kunte H, Schmidt F, Kronenberg G, et al. Olfactory dysfunction in patients with idiopathic intracranial hypertension. Neurology. 2013;81:379-382. https://doi.org/10.1212/wnl.0b013e31829c5c9d

Friedman DI, Jacobson DM. Idiopathic intracranial hypertension. J Neuro Ophthalmol. 2004; 24 :138-145. https://doi.org/10.1097/00041327-200406000-00009

Passi N, Degnan AJ, Levy LM. MR imaging of papilledema and visual pathways: effects of increased intracranial pressure and pathophysiologic mechanisms. AJNR Am J Neuroradiol .2013924-34:919.https://doi.org/10.3174/ajnr.a3022

Bidot S, Bruce BB, Saindane AM, et al. Asymmetric papilledema in idiopathic intracranial hypertension. J Neuro Ophthalmol. 2015;35:31-36.https://doi.org/10.1097/wno.0000000000000205

Frisen L. Swelling of the optic nerve head: a staging scheme. J Neurol Neurosurg Physchiatry .198218-45:13. https://doi.org/10.1136/jnnp.45.1.13

Wall M, George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain.1991;114:155-180.

Hayreh SS. Pathogenesis of optic disc edema in raised intracranial pressure. Trans Ophthalmol Soc UK 1976;96:404-407 .

Corbett JJ, Mehta MP. Cerebrospinal fluid pressure in normal obese subjects and patients with pseudotumor cerebri. Neurology. 1983;33:1386-1388. https://doi.org/10.1212/wnl.33.10.1386

Orcutt JC, Page NG, Sanders MD. Factors affecting visual loss in benign intracranial hypertension. Ophthalmology. 1984;91:1303-1312. https://doi.org/10.1016/s0161-6420(84)34149-5

Kupersmith MJ, Gamell L, Turbin R, et al. Effects weight loss on the course of idiopathic intracranial hypertension in women. Neurology. 1998;50:1094-1098. https://doi.org/10.1212/wnl.50.4.1094

Jacobson DM, Berg R, Wall M, et al. Serum Vitamin A concentration is elevated in idiopathic intracranial hypertension.Neurology. 1999;53:1114-1118. https://doi.org/10.1212/wnl.53.5.1114

King JO, Mitchell PJ, Thomson KR, et al. Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology. 2002;58:26-30. https://doi.org/10.1212/wnl.58.1.26

Wall M, McDermott MP, Kieburtz KD, et al. Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA. 2014;311:1641-1651. https://doi.org/10.1001/jama.2014.3312

Finsterer J, Földy D, Fertl E. Topiramate resolves headache from pseudo tumor cerebri. J Pain Symptom Manage. 2006;32:401-402. https://doi.org/10.1016/j.jpainsymman.2006.07.009

Liu GT, Glaser JS, Schatz NJ. High-dose methylprednisolon and acetazolamide for visual loss in pseudotumor cerebri. Am J Ophthalmol. 1994:118:88-96. https://doi.org/10.1016/s0002-9394(14)72847-8

Carter S, Seiff SR. Macular changes in pseudotumor cerebri before and after optic nerve sheath fenestration. Ophthalmology. 1995;102:937-941. https://doi.org/10.1016/s0161-6420(95)30931-1

Menger RP, Connor DE Jr, Thakur JD, et al. A comparison of lumboperitoneal and ventriculoperitoneal shunting for idiopathic intracranial hypertension: an analysis of economic impact and complications using the Nationwide Inpatient Sample. Neurosurg Focus. 2014 Nov;37(5):E4. https://doi.org/10.3171/2014.8.focus14436

DeWecker L. On incision of the optic nerve in cases of neuroretinitis. In: Power H, ed. Report of the fourth International Ophthalmological Congress, 1872. London, United Kingdom: Savill ,Edwards and Co, 1873:11-14 .

Moreau A, Lao KC, Farris BK. Optic nerve sheath decompression: a surgical technique with minimal operative Complications. J Neuro Ophthalmol. 2014;34:34-38.https://doi.org/10.1097/wno.0000000000000065

Keltner JL. Optic nerve sheath decompression. How does it work? Has its time come? Arch Ophthalmol. 1988;106:1365-1369 . https://doi.org/10.1001/archopht.1988.01060140529018

Ngyun R, Carta A, Geleris A, et al. Long-term effect of optic nerve sheath decompression on intracranial pressure in pseudotumor cerebri. Invest Ophthalmol Vis Sci. 1997;38:S388.

Tsai JC, Petrovich MS, Sadun AA. Histopathological and ultrastructural examination of optic nerve sheath decompression. Br J Ophthalmol. 1995 Feb;79(2):182-5.https://doi.org/10.1136/bjo.79.2.182

Alsuhaibani AH, Carter KD, Nerad JA, et al. Effect of optic nerve sheath fenestration on papilledema of the operated and contralateral nonoperated eyes in idiopathic intracranial hypertension.Ophthalmology. 2011;118:412-414. https://doi.org/10.1016/j.ophtha.2010.06.025

Yazıcı Z, Yazıcı B, Tuncel E. Findings of magnetic resonance imaging after optic nerve sheath decompression in patients with idiopathic intracranial hypertension. Am J Ophthalmol. 2007;144:429-435. https://doi.org/10.1016/j.ajo.2007.05.034

Killer HE, Jaggi GP, Flammer J, et al. Cerebrospinal fluid dynamics between the intracranial and the subarachnoid space of the optic nerve: is it always bidirectional? Brain. 2007;130:514-520.https://doi.org/10.1093/brain/awl324


2022-08-07 — Updated on 2022-08-07