A 270-Degree Decompression of Optic Nerve in Refractory Idiopathic Intracranial Hypertension Using an Ultrasonic Aspirator - A Prospective Institutional Study.

BACKGROUND: Although the nonsurgical treatment for idiopathic intracranial hypertension (IIH) involves weight loss, diuretics, and steroids, surgical intervention is required if there is a worsening of symptoms or visual deterioration. OBJECTIVE: To determine the efficacy and complications of transcranial optic nerve sheath fenestration (ONSF) using an ultrasonic aspirator as an adjunct in the treatment of refractory IIH. MATERIAL AND METHODS: This prospective study included all patients with medically refractory IIH with visual deterioration from November 2017 to June 2019. Pterional craniotomy was followed by extradural clinoidectomy and optic foramen bony decompression using an ultrasonic aspirator. All the cases were followed up for changes in visual acuity and field and surgical outcomes. RESULTS: A total of 21 consecutive patients who underwent ONSF in the study period were included for analysis. Improvement in visual acuity was noted in 19/21 (90.47%) patients. Improvement in visual fields was noted in 17/21 (80.95%). Headache improved in 66.67% of patients. Improvement in the fundus picture was noted in 90.47%. Symptoms < 6 months showed better results compared to > 6 months symptom, although statistically nonsignificant (P = 0.2556). A 270-degree optic canal decompression was achieved in all the cases. CONCLUSION: Transcranial optic nerve sheath decompression with a bone ultrasonic aspirator is a safe and direct decompression of the optic nerve in malignant/refractory cases of IIH.

A Rare Case of Sphenoid Encephalocoele Presenting with Fifth Cranial Nerve Involvement.

A 14-year-old girl presented with chronic headache, recurrent episodes of vomiting, fever, and two episodes of generalized tonic clonic seizure in the past 2 months. Neuroimaging revealed herniation of the brain along with the dura through a defect in the left greater wing of the sphenoid. Left pterional craniotomy was carried out. Herniation of the dural sac along with its contents through the bony defect in the greater sphenoid wing was identified lateral to the V2 nerve passing through the foramen rotundum. The dural defect was repaired. Bony defect was covered with a circular titanium plate. The patient did not have cerebrospinal fluid rhinorrhea postoperatively. At 6-month follow-up, she was asymptomatic.