A 270-Degree Decompression of Optic Nerve in Refractory Idiopathic Intracranial Hypertension Using an Ultrasonic Aspirator - A Prospective Institutional Study.

Background: Although the nonsurgical treatment for idiopathic intracranial hypertension (IIH) involves weight loss, diuretics, and steroids, surgical intervention is required if there is a worsening of symptoms or visual deterioration. Objective: To determine the efficacy and complications of transcranial optic nerve sheath fenestration (ONSF) using an ultrasonic aspirator as an adjunct in the treatment of refractory IIH. Material and Methods: This prospective study included all patients with medically refractory IIH with visual deterioration from November 2017 to June 2019. Pterional craniotomy was followed by extradural clinoidectomy and optic foramen bony decompression using an ultrasonic aspirator. All the cases were followed up for changes in visual acuity and field and surgical outcomes. Results: A total of 21 consecutive patients who underwent ONSF in the study period were included for analysis. Improvement in visual acuity was noted in 19/21 (90.47%) patients. Improvement in visual fields was noted in 17/21 (80.95%). Headache improved in 66.67% of patients. Improvement in the fundus picture was noted in 90.47%. Symptoms 6 months symptom, although statistically nonsignificant (P = 0.2556). A 270-degree optic canal decompression was achieved in all the cases. Conclusion: Transcranial optic nerve sheath decompression with a bone ultrasonic aspirator is a safe and direct decompression of the optic nerve in malignant/refractory cases of IIH.