Optic nerve cyst-like formation presenting as a delayed complication of optic nerve sheath fenestration.

Two patients with idiopathic intracranial hypertension underwent optic nerve sheath fenestration. One patient developed decreased vision and choroidal folds 1 month postoperatively. The other patient developed proptosis and pain 9 months postoperatively. Neuroimaging showed a cyst-like structure adjacent to the optic nerve in each patient. In each case, symptoms and signs resolved after surgical excision of the structure.

Intraoperative predictability of temporal artery biopsy results.

PURPOSE: To determine whether inflammatory/granulomatous changes of giant cell arteritis can be grossly identified by the surgeon during temporal artery biopsy to allow institution or discontinuation of steroid therapy without delay. METHODS: The records of 113 consecutive patients operated on by the same surgeon (R.C.K.) between November 2002 and June 2007 were reviewed. Demographic characteristics, date and site of the surgeries, surgical complications, surgeon's intraoperative presumption about the outcome (based on his assessment of the thickness, nodularity, tortuosity, and color/pallor of the arterial wall, blood flow, and the lumen size), and histopathologic biopsy results were collected from the chart review. The main outcome measure was the correspondence of the surgeon's intraoperative impression expressed in the operative note to the ultimate histopathologic diagnosis. RESULTS: After exclusion of 5 cases with incomplete data, the study consisted of 108 patients (78 females and 30 males) with an average age of 72.4 +/- 11.4 years (range, 45-93 years). There were no complications during or after surgery. The surgeon's comment was "grossly positive" in 17 cases, and 15 of these cases were pathologically positive. For all of the cases that the surgeon's impression was negative, the pathology was negative as well (100% negative predictive value). Overall, the surgeon's intraoperative comments had a 100% sensitivity to detect giant cell arteritis. The specificity and accuracy values were 97.9% and 98.2%, respectively. CONCLUSION: The surgeon's intraoperative evaluation of the temporal artery may be extremely valuable in predicting the biopsy result and may allow the surgeon to determine whether steroids could be discontinued in patients in whom the clinical history is not highly suggestive of giant cell arteritis.