Optic Nerve Sheath Fenestration: Current Preferences in Surgical Approach and Biopsy

Rachel K Sobel; Nasreen A Syed; Keith D Carter; Richard C Allen

doi:10.1097/IOP.0000000000000326

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Optic Nerve Sheath Fenestration: Current Preferences in Surgical Approach and Biopsy

Journal article

Peer reviewed

Optic Nerve Sheath Fenestration: Current Preferences in Surgical Approach and Biopsy

Rachel K Sobel, Nasreen A Syed, Keith D Carter and Richard C Allen

Ophthalmic plastic and reconstructive surgery, Vol.31(4), pp.310-312

07/2015

DOI: 10.1097/IOP.0000000000000326

PMID: 26168208

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Abstract

Optic nerve sheath fenestration (ONSF) has evolved since its inception in 1872. Surgical approaches include a lateral orbitotomy, a medial orbitotomy, or a superomedial lid crease. The actual fenestration can be done with slits or a window excision with biopsy. Each variation has its advantages and disadvantages. We describe the current preferences in surgical approach and biopsy for ONSF and examine the value of biopsy in patients who have undergone ONSF. Eight-question survey and retrospective, noncomparative case review. All American Society of Ophthalmic Plastic and Reconstructive Surgeons (ASOPRS) members are invited to participate in a survey and ONSFs from 1998 to 2013 at the University of Iowa Hospital and Clinics. Data from the survey was analyzed and patient records were reviewed. Preferred surgical approach, type of fenestration, and biopsy results. Sixty-four percent of responding ASOPRS members (150/236) have not performed an ONSF in the last year. One third of that group has performed an ONSF in the last 5 years. Fifty-nine percent perform a medial; 10%, a lateral and 31%, a superomedial approach. Seventy-three percent perform a window fenestration, and about half of those surgeons send the specimen for pathologic evaluation. Anecdotally, some biopsies from surgeons who were surveyed have revealed new diagnoses. In a chart review of 90 cases of ONSF, no biopsy gave an unexpected result. The medial approach for ONSF is most common in our respondents; however, the superomedial lid crease incision is gaining popularity for its efficiency and elegance. Three quarters of surgeons remove a window and a quarter fenestrate with slits. Optic nerve sheath biopsy has limited diagnostic value. In the absence of any evidence to suggest a diagnosis other than idiopathic intracranial hypertension, the usefulness of biopsy during fenestration is low.

Humans

Middle Aged

Optic Nerve Diseases - diagnosis

Pseudotumor Cerebri - diagnosis

Child, Preschool

Male

Optic Nerve Diseases - surgery

Ophthalmologic Surgical Procedures

Practice Patterns, Physicians' - statistics & numerical data

Pseudotumor Cerebri - surgery

Ophthalmology - statistics & numerical data

Health Surveys

Biopsy

Adolescent

Decompression, Surgical - methods

Aged, 80 and over

Adult

Female

Surveys and Questionnaires

Aged

Retrospective Studies

Child

Details

Title: Subtitle: Optic Nerve Sheath Fenestration: Current Preferences in Surgical Approach and Biopsy
Creators: Rachel K Sobel - Department of Ophthalmology and Visual Sciences; †Department of Pathology; and ‡Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
Nasreen A Syed
Keith D Carter
Richard C Allen
Resource Type: Journal article
Publication Details: Ophthalmic plastic and reconstructive surgery, Vol.31(4), pp.310-312
Publisher: United States
DOI: 10.1097/IOP.0000000000000326
PMID: 26168208
ISSN: 0740-9303
eISSN: 1537-2677
Language: English
Date published: 07/2015
Academic Unit: Pathology; Otolaryngology; Ophthalmology and Visual Sciences
Record Identifier: 9983980089402771

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23 Times Cited - Web of Science