Optic Nerve Sheath Fenestration for Progressive Visual Loss in Cerebral Venous Sinus Thrombosis: A Long-Term Retrospective Observational Study

被引：0
作者：
Zongshan Li
Lu Cheng
Yang Xu
Qiao Sun
Jian Zhang
Lin Bai
Ting Feng
Song Tan
Huan Wang
Bolin Deng
Qiang Li
Yaxing Gui
Hui Chen
机构：
[1] Shanghai General Hospital,Department of Ophthalmology
[2] Shanghai Jiao Tong University School of Medicine,Department of Neurology
[3] Shanghai General Hospital,Department of Ophthalmology
[4] Shanghai Jiao Tong University School of Medicine,Department of Ophthalmology
[5] Shanghai Key Laboratory of Ocular Fundus Diseases,Department of Neurology
[6] National Clinical Research Center for Eye Diseases,Eastern Hospital
[7] Eye School of Chengdu University of Traditional Chinese Medicine,Department of Ophthalmology
[8] Shanghai Aier Eye Hospital,School of Medicine
[9] Puren Hospital Affiliated to Wuhan University of Science and Technology,undefined
[10] Sichuan Provincial People’s Hospital,undefined
[11] University of Electronic Science and Technology of China,undefined
[12] Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital,undefined
[13] Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital,undefined
[14] University of Electronic Science and Technology of China,undefined
[15] Neurovascular Center,undefined
[16] Changhai Hospital,undefined
[17] Naval Medical University,undefined
[18] University of Electronic Science and Technology of China,undefined
[19] Chengdu Medical College,undefined
[20] University of Shanghai for Science and Technology,undefined
来源：
Neurology and Therapy | 2023年 / 12卷
关键词：
Cerebral venous sinus thrombosis; Optic nerve sheath fenestration; Visual loss; Papilledema; Intracranial hypertension;
D O I：
暂无
中图分类号：
学科分类号：
摘要：
Cerebral venous sinus thrombosis (CVST) is a cerebrovascular disease that generally affects young patients. Medical treatments include anticoagulants, intracranial pressure (ICP)-lowering medications, and repeated lumbar punctures, effectively reducing CVST’s mortality rate. However, CVST still carries a potential risk of progressive vision loss. Optic nerve sheath fenestration (ONSF) has been reported to be effective and safe in protecting visual function of patients with idiopathic intracranial hypertension. However, its efficacy and safety have not been evaluated in visual loss caused by CVST. We were the first to evaluate the efficacy and safety of ONSF in CVST-induced progressive visual loss based on long-term follow-ups. Before ONSF, all patients were still experiencing progressive visual loss despite receiving adequate anticoagulation and ICP-lowering therapy. We found ONSF to be 80.6% (1 week postoperatively) and 60.7% (after long-term follow-up of over 6 months) effective in stabilizing and/or improving visual function as well as 100% effective in papilledema resolution. Moreover, ONSF exhibited a favorable safety profile, with an extremely low complication rate of 5.6% despite under perioperative anticoagulation. Although visual impairment in CVST was reported to be uncommon, it often significantly affects quality of life and social value of patients. Thus, visual loss in CVST deserves more attention from neurologists, neurosurgeons, and ophthalmologists. Considering its efficacy and favorable safety, ONSF could be regarded a potentially important adjunctive approach to resolving progressive visual loss in CVST patients, on the basis of anticoagulation and ICP-lowering therapy.
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页码：441 / 457
页数：16
相关论文
共 101 条
  • [1] Ropper AH(2021)Cerebral venous thrombosis N Engl J Med 385 59-64
  • [2] Klein JP(2007)Cerebral venous thrombosis: an update Lancet Neurol 6 162-170
  • [3] Bousser MG(2020)Presentation and progression of papilledema in cerebral venous sinus thrombosis Am J Ophthalmol 213 1-8
  • [4] Ferro JM(2002)Cerebral Venous Thrombosis Portugese Collaborative Study Group. Long-term prognosis of cerebral vein and dural sinus thrombosis. results of the VENOPORT study Cerebrovasc Dis 13 272-278
  • [5] Liu KC(2011)Analysis of clinical features of ocular presentation in cranial venous sinus thrombosis Eur J Med Res 16 324-327
  • [6] Bhatti MT(2004)Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) Stroke 35 664-670
  • [7] Chen JJ(2009)Delay in the diagnosis of cerebral vein and dural sinus thrombosis: influence on outcome Stroke 40 3133-3138
  • [8] Ferro JM(2018)To predict visual deterioration according to the degree of intracranial hypertension in patients with cerebral venous sinus thrombosis Eur Neurol 80 28-33
  • [9] Lopes MG(2020)Incidence and mortality of cerebral venous thrombosis in a norwegian population Stroke 51 3023-3029
  • [10] Rosas MJ(2000)Pseudotumor cerebri and optic nerve sheath decompression Ophthalmology 107 1907-1912
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