Papilledema surgery: Difference between revisions

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Latest revision as of 17:05, 11 June 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

Overview

Surgical treatment of papilledema depends on the underlying cause. Various surgeries including shunt surgeries, craniotomies and optic nerve sheath fenestration can be done depending on the cause.

Surgery

Shunting

It involves the placement of a ventricular catheter (a tube made ofsilastic), into the cerebral ventricles to bypass the flow obstruction/malfunctioning arachnoidal granulations and drain the excess fluid into other body cavities, from where it can be resorbed. Most shunts drain the fluid into the peritoneal cavity (ventriculo-peritoneal shunt), but alternative sites include the right atrium (ventriculo-atrial shunt), pleural cavity (ventriculo-pleural shunt), and gallbladder. There is some risk of infection being introduced into the brain through these shunts, however, and the shunts must be replaced as the person grows. More recently developed technologies using advanced imaging as well as endoscopic operative techniques have improved the ability of surgeons to place catheters in the ventricles of patients with IIH who do not have ventricular enlargement. ^[1]

Craniotomies

Holes are drilled in the skull to remove intracranial hematomas or relieve pressure from parts of the brain. As raised ICP's may be caused by the presence of a mass, removal of this via craniotomy will decrease raised ICP's.

Optic Nerve Sheath Fenestration

Optic nerve sheath fenestration is a procedure that is advocated for the treatment of certain types of optic nerve dysfunction associated with progressive decline in visual function. Optic nerve sheath fenestration can stabilize or improve visual loss due to papilledema in idiopathic intracranial hypertension. However, it may fail at any time after surgery. Patients with pseudotumor cerebri need to be followed up routinely with automated perimetry to detect deterioration of visual function.^[2]

References

↑ {{cite journal |author=McGirt MJ, Woodworth G, Thomas G, Miller N, Williams M, Rigamonti D |title=Cerebrospinal fluid shunt placement for pseudotumor cerebri-associated intractable headache: predictors of treatment response and an analysis of long-term outcomes |journal=J. Neurosurg. |volume=101 |issue=4 |pages=627–32 |year=2004 |month=October |pmid=15481717 |doi=10.3171/jns.2004.101.4.0627 |url=}
↑ Spoor TC, McHenry JG (1993). "Long-term effectiveness of optic nerve sheath decompression for pseudotumor cerebri". Arch. Ophthalmol. 111 (5): 632–5. PMID 8489443. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[1] {{cite journal |author=McGirt MJ, Woodworth G, Thomas G, Miller N, Williams M, Rigamonti D |title=Cerebrospinal fluid shunt placement for pseudotumor cerebri-associated intractable headache: predictors of treatment response and an analysis of long-term outcomes |journal=J. Neurosurg. |volume=101 |issue=4 |pages=627–32 |year=2004 |month=October |pmid=15481717 |doi=10.3171/jns.2004.101.4.0627 |url=}

[2] Spoor TC, McHenry JG (1993). "Long-term effectiveness of optic nerve sheath decompression for pseudotumor cerebri". Arch. Ophthalmol. 111 (5): 632–5. PMID 8489443. Unknown parameter |month= ignored (help)

[1]

[2]

@@ Line 1: / Line 1: @@
+__NOTOC__
 {{Papilledema}}
-{{CMG}} Associate Editor(s)-In-Chief: Kalsang Dolma, MBBS
+{{CMG}}; {{AE}} {{KD}}
+==Overview==
+Surgical treatment of papilledema depends on the underlying cause. Various surgeries including shunt surgeries, craniotomies and optic nerve sheath fenestration can be done depending on the cause.
 ==Surgery==
+===[[Shunting]]===
+It involves the placement of a [[catheter|ventricular catheter]] (a tube made of[[silastic]]), into the [[ventricle (brain)|cerebral ventricles]] to bypass the flow obstruction/malfunctioning [[arachnoid villi|arachnoidal granulations]] and drain the excess fluid into other body cavities, from where it can be resorbed. Most shunts drain the fluid into the [[peritoneum|peritoneal cavity]] ([[shunt (medical)|ventriculo-peritoneal shunt]]), but alternative sites include the [[right atrium]] ([[shunt (medical)|ventriculo-atrial shunt]]), [[pleura|pleural cavity]] ([[shunt (medical)|ventriculo-pleural shunt]]), and [[gallbladder]]. There is some risk of [[infection]] being introduced into the brain through these shunts, however, and the shunts must be replaced as the person grows. More recently developed technologies using advanced imaging as well as endoscopic operative techniques have improved the ability of surgeons to place catheters in the ventricles of patients with IIH who do not have ventricular enlargement. <ref>{{cite journal |author=McGirt MJ, Woodworth G, Thomas G, Miller N, Williams M, Rigamonti D |title=Cerebrospinal fluid shunt placement for pseudotumor cerebri-associated intractable headache: predictors of treatment response and an analysis of long-term outcomes |journal=J. Neurosurg. |volume=101 |issue=4 |pages=627–32 |year=2004 |month=October |pmid=15481717 |doi=10.3171/jns.2004.101.4.0627 |url=}</ref>
-'''[[Shunting]]:''' It involves the placement of a [[catheter|ventricular catheter]] (a tube made of[[silastic]]), into the [[ventricle (brain)|cerebral ventricles]] to bypass the flow obstruction/malfunctioning [[arachnoid villi|arachnoidal granulations]] and drain the excess fluid into other body cavities, from where it can be resorbed.
+===[[craniotomy|Craniotomies]]===
-Most shunts drain the fluid into the [[peritoneum|peritoneal cavity]] ([[shunt (medical)|ventriculo-peritoneal shunt]]), but alternative sites include the [[right atrium]] ([[shunt (medical)|ventriculo-atrial shunt]]), [[pleura|pleural cavity]] ([[shunt (medical)|ventriculo-pleural shunt]]), and [[gallbladder]]There is some risk of [[infection]] being introduced into the brain through these shunts, however, and the shunts must be replaced as the person grows.
+Holes are drilled in the skull to remove [[intracranial hematoma]]s or relieve pressure from parts of the brain. As raised ICP's may be caused by the presence of a mass, removal of this via craniotomy will decrease raised ICP's.
-                       More recently developed technologies using advanced imaging as well as endoscopic operative techniques have improved the ability of surgeons to place catheters in the ventricles of patients with IIH who do not have ventricular enlargement. <ref>{{cite journal |author=McGirt MJ, Woodworth G, Thomas G, Miller N, Williams M, Rigamonti D |title=Cerebrospinal fluid shunt placement for pseudotumor cerebri-associated intractable headache: predictors of treatment response and an analysis of long-term outcomes |journal=J. Neurosurg. |volume=101 |issue=4 |pages=627–32 |year=2004 |month=October |pmid=15481717 |doi=10.3171/jns.2004.101.4.0627 |url=}</ref>
-'''[[craniotomy|Craniotomies]]:''' Holes drilled in the skull to remove [[intracranial hematoma]]s or relieve pressure from parts of the brain.<ref name="orlando"/> As raised ICP's may be caused by the presence of a mass, removal of this via craniotomy will decrease raised ICP's.
+===Optic Nerve Sheath Fenestration===
+Optic nerve sheath fenestration is a procedure that is advocated for the treatment of certain types of [[optic nerve]] dysfunction associated with progressive decline in visual function. Optic nerve sheath fenestration can stabilize or improve visual loss due to papilledema in idiopathic intracranial hypertension. However, it may fail at any time after surgery. Patients with pseudotumor cerebri need to be followed up routinely with automated perimetry to detect deterioration of visual function.<ref>{{cite journal |author=Spoor TC, McHenry JG |title=Long-term effectiveness of optic nerve sheath decompression for pseudotumor cerebri |journal=Arch. Ophthalmol. |volume=111 |issue=5 |pages=632–5 |year=1993 |month=May |pmid=8489443 |doi= |url=}}</ref>
-[['''Optic nerve sheath fenestration]]''' — Optic nerve sheath decompression (ONSD) is a procedure that is advocated for the treatment of certain types of optic nerve dysfunction associated with progressive decline in visual function.
+==References==
-Optic nerve sheath fenestration (ONSF) can stabilize or improve visual loss due to papilledema in IIH However, it may fail at any time after surgery. Patients with PTC need to be followed up routinely with automated perimetry to detect deterioration of visual function.<ref>{{cite journal |author=Spoor TC, McHenry JG |title=Long-term effectiveness of optic nerve sheath decompression for pseudotumor cerebri |journal=Arch. Ophthalmol. |volume=111 |issue=5 |pages=632–5 |year=1993 |month=May |pmid=8489443 |doi= |url=}}</ref>
+{{reflist|2}}
+[[Category:Neurology]]
+[[Category:Emergency medicine]]
+[[Category:Intensive care medicine]]
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