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

Autor: 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
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Neurology and Therapy, Vol 12, Iss 2, Pp 441-457 (2023)
Druh dokumentu: article
ISSN: 2193-8253
2193-6536
DOI: 10.1007/s40120-022-00434-9
Popis: Plain Language Summary 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. Procedural videos available for this article.
Databáze: Directory of Open Access Journals
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