Endoscopic optic nerve sheath fenestration for treatment of papilledema secondary to intracranial venous hypertension: Report of two cases

Objective: To determine the safety and efficacy of endoscopic optic nerve sheath fenestration (ONSF) for the reversal of papilledema in intracranial venous hypertension. Material and Method: A retrospective chart review was performed on two consecutive patients who underwent endoscopic ONSF. Presenting symptoms, neuro-ophthalmological work-ups, including visual acuity (VA), visual field charting (VF), optical coherence tomography (OCT) and MRI as well as magnetic resonance venography (MRV) were recorded. Cerebrospinal fluid pressure was also measured preoperatively in both individuals. Visual improvement was assessed by comparing with preoperative ophthalmological findings. Results: This report is the first endoscopic ONSF study focusing on treatment of papilledema resulting from intracranial venous hypertension (tumor compressing transverse sigmoid junction in the first patient and venous sinus stenosis in the second patient). ONSF was performed on both sides of the first patient and on the right optic nerve of the second patient with showing reduction of papilledema on both eyes. Papilledema was improved in both individuals. Vision improved more in the first patient than in the second whom had pre-existing optic nerve atrophy. Conclusion: Endoscopic optic nerve sheath fenestration is an effective and safe procedure to revert visual loss or to stabilize vision in patients presenting with visual loss caused by intracranial venous hypertension.