Outcomes of Optic Nerve Sheath Fenestration Surgery in Children with Pseudotumor Cerebri Syndrome
-
By
-
Osman Parca
-
Emine Seker-Un
-
November 26, 2025
-
Clinical Scorecard: Outcomes of Optic Nerve Sheath Fenestration Surgery in Children with Pseudotumor Cerebri Syndrome
At a Glance
| Category | Detail |
|---|
| Condition | Pseudotumor Cerebri Syndrome (PTCS) - includes primary and secondary forms |
| Key Mechanisms | Elevated intracranial pressure with normal cerebrospinal fluid composition |
| Target Population | Pediatric patients with medically-resistant PTCS |
| Care Setting | Tertiary referral hospital |
Key Highlights
- PTCS incidence in children is estimated at 0.5 to 1.2 per 100,000.
- First-line treatments include weight loss, acetazolamide, and topiramate.
- Approximately 10% of pediatric PTCS cases require surgical intervention, including ONSF, CSF shunts, and venous sinus stenting.
- Optic nerve sheath fenestration (ONSF) is preferred for direct optic nerve decompression.
- The study evaluates ONSF outcomes in pediatric patients from 2018 to 2023.
Guideline-Based Recommendations
Diagnosis
- Diagnosis based on revised Friedman criteria.
- Lumbar puncture to assess opening pressure.
Management
- First-line treatments: weight loss, acetazolamide, topiramate.
- Surgical options include ONSF, CSF shunts, and venous sinus stenting.
Monitoring & Follow-up
- Regular neuro-ophthalmologic assessments post-surgery.
- Follow-up evaluations at 1 day, 1 week, 1 month, 3 months, 6 months, and beyond.
Risks
- Potential for inadequate response to medical therapy.
- Surgical risks associated with ONSF and other interventions.
Patient & Prescribing Data
Pediatric patients with PTCS-related papilledema.
Surgical intervention is considered for progressive visual deterioration despite medical therapy.
Clinical Best Practices
- Perform comprehensive assessments to confirm PTCS diagnosis.
- Utilize ONSF for patients with severe vision loss and inadequate medical response.
- Monitor visual acuity and visual field parameters regularly, considering comorbidities.
References
