Pseudotumor cerebri and optic nerve sheath decompression.

OBJECTIVE: To determine the efficacy and safety of optic nerve sheath decompression in a large population of patients with pseudotumor cerebri with visual loss despite medical treatment and to suggest a treatment algorithm on the basis of these data.

DESIGN: Retrospective, noncomparative, interventional case series.

PARTICIPANTS: One hundred fifty-eight eyes in 86 patients with pseudotumor cerebri.

INTERVENTION: Optic nerve sheath decompression.

MAIN OUTCOME MEASURES: Visual acuity, visual fields, and surgical complications.

RESULTS: After optic nerve sheath decompression for pseudotumor cerebri, visual acuity stabilized or improved in 148 of 158 (94%) eyes, and visual fields stabilized or improved in 71 of 81 (88%) eyes. Surgical complications, most of which were transient and benign, were seen in 39 of 86 patients. Only one eye in one patient had permanent severe visual loss secondary to an operative complication.

CONCLUSIONS: In patients with pseudotumor cerebri with progressive visual loss despite maximum medical therapy, optic nerve sheath decompression is a safe and effective means of stabilizing visual acuity and the visual fields of those tested.