Long-Term Results of Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension: Earlier Intervention Favours Improved Outcomes

The role of optic nerve sheath fenestration (ONSF) in the management of idiopathic intracranial hypertension remains controversial, with indications, risks, and benefits compared to cerebro-spinal fluid diversion procedures not fully elucidated. We report a retrospective record review of 37 patients (50 eyes) which had undergone ONSF by a single surgeon. Visual acuity (VA) improved in 22% of operated eyes and 17% of fellow eyes; stabilized in 54% of operated and 74% of fellow eyes; and deteriorated in 24% of operated and 9% of fellow eyes. Better pre-operative VA (p = 0.01), colour vision (p = 0.002), and earlier intervention (p = 0.04) were associated with stabilization. We conclude that ONSF often stabilizes vision and visual fields. Our results were best in patients with better pre-operative vision and in those with earlier intervention.