April 2010

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Purpose. Chronic intracranial hypertension (IH) can lead to visual impairment in an estimated 25% to 50% of those afflicted. Optic nerve sheath decompression (ONSD) or fenestration has been shown to be an effective form of vision preservation with improvement in visual acuity (VA) and visual fields (VF). The purpose of this study was to examine the role of underlying etiology in IH, examine factors related to IH treatment paths, and preoperative factors leading to a successful outcome in VA and VF after ONSD intervention. Methods. This study was an observational retrospective cohort of 1028 eyes in 514 of chronic intracranial hypertension cases from the Intracranial Hypertension Registry, Portland, Oregon. Main outcome measures included visual acuity and visual fields. Results. The signs and symptoms of intracranial hypertension did not differ according to etiology. Those that underwent an ONSD procedure as the first procedure had worse visual symptoms at diagnosis than those that remained medically treated. Stabilization/Improvement post-ONSD over a short-term and long-term follow-up was associated with worse visual acuity pre-ONSD surgery (odds ratio = 0.86, confidence interval 0.77, 0.96, p = 0.01) adjusting for time to surgery. Conclusion. Diagnostic signs and symptoms of IH are poor predictors of successful VF and VA outcomes after ONSD surgery. ONSD appears to be an effective stop gap measure for preserving abnormal vision in chronic intracranial hypertension but should not be considered as a long-term treatment intervention.




School of Medicine



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