Optic Nerve Sheath Decompression

In 1872 DeWecker described a surgical procedure lor the treatment of optic disc edema. Through a lower temporal conjunctival incision, he identified the optic nerve by palpation and incised nerve sheath blindly with a guarded knife. His indication lor surgery in the two cases reported was chronic optic disc edema; both patients demonstrated resolution of this sign. The surgical technique has undergone several important revisions. Carter first recommended direct observation of the nerve sheath in 1887. His fenestration consisted of a 6 mm long incision through the dura. Thirty years later, Muller suggested excision of a rectangle of dura. Complications of the surgery were reported by Marberg in 1921; live patients all had decreased vision after surgery, 3 of whom were believed to have had definite optic nerve damage by the surgery. Isolated cases continued to be described but the technique was superseded by neurosurgical procedures for he relief of elevated intracranial pressure.