MANAGEMENT OF VISUAL-LOSS AFTER OPTIC-NERVE SHEATH DECOMPRESSION IN PATIENTS WITH PSEUDOTUMOR CEREBRI

Purpose: To determine the appropriate management of patients with pseu dotumor cerebri with early, progressive visual loss after optic nerve sheath decompression (ONSD). Methods: The records of all patients with pseudotumor cerebri who underwent ONSD were reviewed retrospectively. Patients who showed visual loss within 1 month of surgery were studie d. Results: Five patients with pseudotumor cerebri, including two with renal failure and hypertension, had visual loss within 1 month of ONS D. The first patient had an abrupt decrease in vision 6 days after ONS D. In this patient, a vessel on the nerve sheath bled into the surgica l site. At the time of ONSD, this patient had a visual acuity of 20/20 1 day after surgery. Six days later, visual acuity decreased to 20/20 0. After high-dose intravenous corticosteroids failed to improve visio n, emergency lumboperitoneal shunt resulted in full visual recovery. A n apparent infectious optic neuropathy developed in the second patient 3 days after surgery. After 72 hours of intravenous antibiotics, visu al acuity improved from 20/600 to 20/15. The other three patients had gradual visual loss after ONSD, which stabilized after lumboperitoneal shunts. Conclusions: Avoidance of bleeding during ONSD may prevent fi brous occlusion of the surgical site. Patients with no identifiable ca use for visual loss after ONSD, who do not respond to intravenous cort icosteroids, should be evaluated for emergency lumboperitoneal shuntin g. Postoperative infectious optic neuropathy should be considered in t he differential diagnosis of abrupt visual loss after ONSD.