Pseudotumor cerebri surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Indications
Surgery is not the first-line treatment option for patients with pseudotumor cerebri. Surgery is usually reserved for patients with either:
- Progress of visual field loss despite medical treatment with maximum dosage
- Visual acuity loss which is the result of papilledema
- Resistant headache
- hypotension[1]
Surgery
Surgical options are:
Optic nerve sheath fenestration
In IIH patients with papilledema, optic nerve sheath fenestration (ONSF) can improve visual loss.[2]
Shunting
Ventriculoperitoneal and lumboperitoneal shunting can reduce headaches, diplopia, papilledema and visual loss in IIH patients.[2][3][4][5]
Venous sinus stenting
We can perform venous stenting in patients with venous sinus stenosis on cerebral venography. This method can reduce headaches and visual problems.[6][7]
References
- ↑ Corbett JJ, Thompson HS (October 1989). "The rational management of idiopathic intracranial hypertension". Arch. Neurol. 46 (10): 1049–51. PMID 2679506.
- ↑ 2.0 2.1 Biousse V, Bruce BB, Newman NJ (May 2012). "Update on the pathophysiology and management of idiopathic intracranial hypertension". J. Neurol. Neurosurg. Psychiatry. 83 (5): 488–94. doi:10.1136/jnnp-2011-302029. PMC 3544160. PMID 22423118.
- ↑ Fonseca PL, Rigamonti D, Miller NR, Subramanian PS (October 2014). "Visual outcomes of surgical intervention for pseudotumour cerebri: optic nerve sheath fenestration versus cerebrospinal fluid diversion". Br J Ophthalmol. 98 (10): 1360–3. doi:10.1136/bjophthalmol-2014-304953. PMID 24820047.
- ↑ Burgett RA, Purvin VA, Kawasaki A (September 1997). "Lumboperitoneal shunting for pseudotumor cerebri". Neurology. 49 (3): 734–9. PMID 9305333.
- ↑ Lundar T, Nornes H (1990). "Pseudotumour cerebri-neurosurgical considerations". Acta Neurochir Suppl (Wien). 51: 366–8. PMID 2089940.
- ↑ Ahmed RM, Wilkinson M, Parker GD, Thurtell MJ, Macdonald J, McCluskey PJ, Allan R, Dunne V, Hanlon M, Owler BK, Halmagyi GM (September 2011). "Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions". AJNR Am J Neuroradiol. 32 (8): 1408–14. doi:10.3174/ajnr.A2575. PMID 21799038.
- ↑ Puffer RC, Mustafa W, Lanzino G (September 2013). "Venous sinus stenting for idiopathic intracranial hypertension: a review of the literature". J Neurointerv Surg. 5 (5): 483–6. doi:10.1136/neurintsurg-2012-010468. PMID 22863980.