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Optic nerve decompression. A clinical pathologic study.

J L Keltner, D M Albert, M Lubow

    Archives of Ophthalmology (Chicago, Ill. : 1960)
    |January 1, 1977
    PubMed
    Summary
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    Surgical decompression of optic nerve meninges may relieve chronic papilledema by allowing cerebrospinal fluid (CSF) to egress through dural fistulas. This procedure offers a potential treatment for papilledema in specific neurological conditions.

    Area of Science:

    • Neurosurgery
    • Ophthalmology
    • Neuropathology

    Background:

    • Intractable chronic papilledema can be a debilitating condition, often associated with increased intracranial pressure.
    • Glioblastoma multiforme is an aggressive primary brain tumor requiring complex management.
    • Surgical intervention, such as optic nerve decompression, is considered for severe cases unresponsive to other treatments.

    Observation:

    • A patient with glioblastoma multiforme underwent perioptic meningeal decompression for chronic papilledema.
    • Histologic examination revealed dural fistulas facilitating cerebrospinal fluid (CSF) egress and maintaining the subarachnoid space.
    • Two additional patients experienced bilateral papilledema resolution after unilateral optic nerve decompression.

    Findings:

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  • Cerebrospinal fluid (CSF) egress through surgically created dural fistulas is proposed as the primary mechanism for papilledema resolution.
  • The duration of dural fistula patency remains an undetermined factor in the long-term efficacy of the procedure.
  • Observed variations in surgical outcomes may be attributed to anatomical differences, pathology, surgical techniques, and individual patient responses.

    • Implications:

    • Optic nerve decompression may offer a viable therapeutic option for intractable papilledema, particularly when linked to CSF dynamics.
    • Understanding the role of CSF egress is crucial for optimizing surgical strategies and patient selection.
    • Further research is warranted to elucidate the long-term effects and refine surgical techniques for optic nerve decompression in papilledema management.