Skip to main content
SpringerLink
Log in

Indikation und Technik der Optikusscheidenfensterung

Indications and technique of optic nerve sheath fenestration

  • Das therapeutische Prinzip
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Eine Optikusscheidenfensterung ist dann indiziert, wenn bei Stauungspapillen trotz vorheriger, konservativer Maßnahmen ein Sehverlust droht und die Ursache des erhöhten Hirndrucks nicht identifiziert und eliminiert werden kann. Diese Konstellation ist selten. Sie tritt meist bei idiopathischer intrakranieller Hypertension auf. Die Optikusscheidenfensterung erfolgt in Vollnarkose über einen transkonjunktivalen Zugang. Stehen nicht Sehstörungen, sondern Kopfschmerzen oder andere neurologische Symptome im Vordergrund, ist ein ventrikulärer Shunt vorzuziehen. Diese Übersichtsarbeit informiert über das Krankheitsbild der idiopathischen intrakraniellen Hypertension, die Operationstechnik und ihre Ergebnisse.

Abstract

An optic nerve sheath fenestration is indicated when papilloedema leads to progressive visual loss despite previous, conservative measures and when no cause of increased intracranial pressure can be indentified and eliminated. This rather rare constellation usually occurs in idiopathic intracranial hypertension. The procedure is performed via a medial transconjunctival orbitotomy. If headaches and neurologic symptoms other than visual deterioration prevail, the placement of a ventricular shunt is preferred. This review covers the symptoms of idiopathic intracranial hypertension and optic nerve sheath fenestration with its technical aspects and results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Acheson J (2004) Optic nerve disorders: role of canal and nerve sheath decompression surgery. Eye 18:1169–1174

    Article  PubMed  CAS  Google Scholar 

  2. Agarwal M, Yoo J (2007) Optic nerve sheath fenestration for vision preservation in idiopathic intracranial hypertension. Neurosurg Focus 23:E7

    Article  PubMed  Google Scholar 

  3. Ahlskog J, O’neill B (1982) Pseudotumor cerebri. Ann Intern Med 97:249–256

    PubMed  CAS  Google Scholar 

  4. n a (2000) Ischemic Optic Neuropathy Decompression Trial: twenty-four-month update. Arch Ophthalmol 118:793–798

    Google Scholar 

  5. Chandrasekaran S, Mccluskey P, Minassian D et al (2006) Visual outcomes for optic nerve sheath fenestration in pseudotumour cerebri and related conditions. Clin Experiment Ophthalmol 34:661–665

    Article  PubMed  Google Scholar 

  6. Corbett J, Savino P, Thompson H et al (1982) Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol 39:461–474

    PubMed  CAS  Google Scholar 

  7. Durcan F, Corbett J, Wall M (1988) The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana. Arch Neurol 45:875–877

    PubMed  CAS  Google Scholar 

  8. Feldon S (2007) Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension. Neurosurg Focus 23:E6

    Article  PubMed  Google Scholar 

  9. Lagrèze W (2001) Differentialdiagnose der Papillenschwellung. Ophthalmologe 98:417–431

    Article  PubMed  Google Scholar 

  10. Lessell S (1992) Pediatric pseudotumor cerebri (idiopathic intracranial hypertension). Surv Ophthalmol 37:155–166

    Article  PubMed  CAS  Google Scholar 

  11. Lueck C, Mcilwaine G (2005) Interventions for idiopathic intracranial hypertension. Cochrane Database Syst Rev:CD003434

    Google Scholar 

  12. Mathews M, Sergott R, Savino P (2003) Pseudotumor cerebri. Curr Opin Ophthalmol 14:364–370

    Article  PubMed  Google Scholar 

  13. Newborg B (1974) Pseudotumor cerebri treated by rice reduction diet. Arch Intern Med 133:802–807

    Article  PubMed  CAS  Google Scholar 

  14. Querfurth H, Arms S, Lichy C et al (2004) Prediction of intracranial pressure from noninvasive transocular venous and arterial hemodynamic measurements: a pilot study. Neurocrit Care 1:183–194

    Article  PubMed  Google Scholar 

  15. Seiff S, Shah L (1990) A model for the mechanism of optic nerve sheath fenestration. Arch Ophthalmol 108:1326–1329

    PubMed  CAS  Google Scholar 

  16. Sergott R (1986) Diagnosis and management of vision-threatening papilledema. Semin Neurol 6:176–184

    Article  PubMed  CAS  Google Scholar 

  17. Steffen H, Eifert B, Aschoff A et al (1996) The diagnostic value of optic disc evaluation in acute elevated intracranial pressure. Ophthalmology 103:1229–1232

    PubMed  CAS  Google Scholar 

  18. Thambisetty M, Lavin P, Newman NJ et al (2007) Fulminant idiopathic intracranial hypertension. Neurology 68:229–232

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Universitäts-Augenklinik Freiburg, Killianstraße 5, 79106, Freiburg, Deutschland

    W.A. Lagrèze

Authors
  1. W.A. Lagrèze
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W.A. Lagrèze.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lagrèze, W. Indikation und Technik der Optikusscheidenfensterung. Ophthalmologe 106, 452–456 (2009). https://doi.org/10.1007/s00347-009-1922-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-009-1922-4

Schlüsselwörter

Keywords

Search

Navigation