Outcomes of Optic Nerve Sheath Fenestration Surgery in Children with Pseudotumor Cerebri Syndrome

Overview

This study evaluates the effectiveness and safety of optic nerve sheath fenestration (ONSF) in pediatric patients with pseudotumor cerebri syndrome (PTCS) who are resistant to medical therapy. The findings indicate that ONSF can provide significant visual and structural benefits in this population.

Background

Pseudotumor cerebri syndrome (PTCS) is characterized by elevated intracranial pressure without an identifiable mass, particularly affecting children. The condition can lead to severe complications, including vision loss, necessitating effective treatment strategies. Surgical interventions like ONSF are critical for patients who do not respond adequately to medical management.

Data Highlights

This study is a retrospective case series evaluating clinical outcomes in pediatric patients undergoing ONSF for PTCS.

Key Findings

• ONSF was performed on pediatric patients with PTCS who had inadequate response to medical therapy.
• All patients underwent comprehensive neuro-ophthalmologic assessments prior to surgery.
• ONSF provided direct optic nerve decompression with a lower systemic complication risk compared to CSF shunt procedures.
• Visual acuity and papilledema grading were used to assess outcomes post-surgery.
• Approximately 10% of pediatric PTCS cases require surgical intervention due to inadequate medical response.

Clinical Implications

The study underscores the importance of timely surgical intervention in pediatric PTCS cases that do not respond to medical therapy. ONSF may be a preferred surgical option for patients with significant visual threat, providing a direct method to relieve intracranial pressure.

Conclusion

Optic nerve sheath fenestration appears to be a safe and effective surgical option for managing pediatric patients with medically-resistant pseudotumor cerebri syndrome, potentially preventing vision loss.

Related Resources & Content

1. Surgical Approach to Optic Nerve Decompression in a Pediatric Case of Osteopetrosis, Springer, 2025 -- Surgical Approach to Optic Nerve Decompression in a Pediatric Case of Osteopetrosis
2. Microsurgical Fenestration of Pineal Cysts: An Effective and Safe Approach for Managing Symptomatic Pineal Cyst Syndrome, Springer, 2025 -- Microsurgical Fenestration of Pineal Cysts
3. Management of Glaucoma Following Cataract Surgery in Children, Glaucoma Physician, 2021 -- Management of Glaucoma Following Cataract Surgery in Children
4. A systematic review of surgical and interventional radiology procedures for pediatric idiopathic intracranial hypertension, Frontiers in Pediatrics, 2024 -- A systematic review of surgical and interventional radiology procedures for pediatric idiopathic intracranial hypertension
5. Evaluation of Surgical Techniques and Outcomes for Symptomatic Pineal Cysts: Microscopic/Endoscopic Fenestration Compared to Stereotactic Catheter Placement
6. Acetazolamide for Idiopathic Intracranial Hypertension: An Up-to-Date Review in 2025
7. Surgical outcomes of optic nerve sheath fenestration in pediatric pseudotumor cerebri syndrome
8. A systematic review of surgical andinterventional radiology procedures for pediatric idiopathic intracranial hypertension