Purpose: To evaluate the factors that can affect the success of optic nelVe sheath decompression operation. to save the visual functions in both eyes. Also the role of MRI in cases of papilloedema due to pseudotumer cerebri. Also timing of surgery and its role to save vision.
I Methods: Fifteen patients having pseudotumer cerebri failed to respond to medical treatment with deterioration of their visual functions . were selected to do optic nelVe sheath decompression operation. either to one eye or the other eye needed reoperation. MRI was done to all cases at time of reference.
Duration of papilloedema prior to surgical interference was recorded. Optic nelVe sheath appearance during surgical exposure was recorded. the rate of flow of CSF on opening the sheath was noted. and also su barachnoid trabeculations were opened. Follow up ranged from fourteen months to four years.
Results:MRI of early treated cases of pseudotumer cerebri show marked distension and ballooning of optic nelVe sheath. as the duration of papilloedema increases the distention decreases. During surgical exposure this distention was apparent in the early treated cases also there was marked gush of CSF on opening the sheath. Subarachnoid trabeculations were opened to facilitate flow of CSF. Early treated cases resumed visual functions and resolved papilloedema after surgery for one eye. As the duration of papilloedema increases. there is a need to do surgery for both eyes. If chronic atrophic changes occurred the results of surgery become poor.
Conclusion: If medical treatment failed to resolve papilloedema or visual funct~ti$ are deteriorating. surgical decision must be taken to save vision in cases of papilloedema due to pseudotumer cerebri. MRI has to be done to all cases of pseudolumer cerebri. |
