Can We Repeat an ONSF?

Idiopathic intracranial hypertension (IIH) is a growing problem associated with headaches but most importantly to ophthalmologists vision loss. For patients with mild to moderate vision loss, medical management is typically sufficient for control of symptoms and resolution of papilledema. However, in patients with severe or progressive visual loss despite medical management, surgical intervention may be required. There is no clear consensus on what surgical procedure should is best, but in general many believe that a cerebrospinal fluid (CSF) shunting procedure is indicated in patients with mostly headache symptoms, while an optic nerve sheath decompression (ONSD) is indicated for primarily visual loss though some patients have enjoyed improvement in headache after ONSD only. Venous sinus stenting is a newer approach to manage venous sinus stenosis, but has limited literature and again no comparative studies to demonstrate its true role. Studies have noted failure of ONSD in up to 32% of eyes after initial success at a mean of 10.4 months (Spor et al, 1993), while the reoperation rate has been reported at up to 4% (Sergott et al., 1990). There is no consensus in the literature on the best next step for these patients.