A Comparison of Outcomes Between Two Techniques for Optic Nerve Sheath Fenestration

Patients with increased intracranial pressure (ICP) and papilledema are at risk for vision loss. Increased ICP may be managed medically, however, severe cases often require surgical intervention such as optic nerve sheath fenestration (ONSF).1-3 ONSF has been shown to stabilize vision and in some cases improve visual acuity and reverse visual field loss.4-7 At our institution, two different surgical techniques have been employed for ONSF-the medial upper lid crease orbitotomy (MULC), and the superior nasal transconjunctival approach (SNTC).8-10 In the literature, there are no direct comparisons of outcomes between these techniques, particularly by the same surgeon. We compared these two techniques to determine if there is a difference in visual field mean deviation, visual acuity, and surgical complications after ONSF.