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McCluskey PJ, Lam D, Ang T, Todd MJ, Halmágyi GM. Optic nerve sheath fenestration for treating papilloedema in the era of cerebral venous sinus stenting. Clin Exp Ophthalmol 2023. [PMID: 36754636 DOI: 10.1111/ceo.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Pseudotumour cerebri (PTC) is the syndrome of intracranial hypertension without intracranial mass or hydrocephalus and is the commonest cause of papilloedema seen in many eye clinics. In the last 10 years, we have increasingly used TSS in patients whose papilloedema was not well controlled with medical treatment and have done fewer ONSFs. Here, we review our experience at Royal Prince Alfred Hospital Sydney with ONSF in 35 patients over the period 2002-2021. METHODS Retrospective case series of 35 patients, 30 of whom had primary PTC [i.e., idiopathic intracranial hypertension (IIH)] and 5 with secondary PTC. RESULTS Eighteen patients had bilateral ONSF and 17 patients unilateral ONSF, in each case of the worse eye. Thirteen patients then underwent transverse sinus stenting (TSS), in each case following ONSF. The primary outcome measures were visual acuity (VA) and mean deviation (MD) on visual field (VF) testing. MD improved by 5 dB or more in 34 of 70 total eyes (48.6%); VA improved by 0.2 logMAR (two lines on Snellen chart) or more in 21 eyes (30%), and by both in 15 eyes (21.4%). Final MD was -10 dB or better in 38 eyes (54.3%); final VA was 0.3 (6/12) or better in 54 eyes (77.1%), and both in 39 eyes (55.7%). CONCLUSIONS The results confirm that ONSF can relieve papilloedoema in both eyes and improve both VF and VA, even in cases of fulminant PTC with severe acute visual impairment.
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Affiliation(s)
- Peter J McCluskey
- Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, Specialty of Ophthalmology, Faculty of Medicine and Health, Sydney, University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Danny Lam
- Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Save Sight Institute, Specialty of Ophthalmology, Faculty of Medicine and Health, Sydney, University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Timothy Ang
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael J Todd
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Gábor M Halmágyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Ala RT, Yener G, Özer E, Men S, Bülbül HM, Yaman A, Söylev Bajin M, Colakoglu BD, Akdal G, Halmágyi GM. Adult Spinal Primary Leptomeningeal Medulloblastoma Presenting as Pseudotumour Cerebri Syndrome. Neuroophthalmology 2020; 45:205-210. [PMID: 34194127 DOI: 10.1080/01658107.2020.1791191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A previously well 34-year-old man presented with severe pseudotumour cerebri. Imaging showed that he had a cauda equina tumour which proved to be a medulloblastoma. There was no tumour mass in the posterior fossa so we assume that this was a primary leptomeningeal medulloblastoma. In patients with somewhat atypical pseudotumour, spinal imaging should always be considered.
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Affiliation(s)
- Rahmi Tümay Ala
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey
| | - Görsev Yener
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Erdener Özer
- International Biomedicine and Genome Center, Dokuz Eylül University, Izmir, Turkey
| | - Süleyman Men
- Department of Pathology, Dokuz Eylül University, Izmir, Turkey
| | | | - Aylin Yaman
- Department of Radiology, Dokuz Eylül University, Izmir, Turkey
| | | | | | - Gülden Akdal
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey.,Department of Ophthalmology, Dokuz Eylül University, Izmir, Turkey
| | - Gábor Michael Halmágyi
- Department of Neuroscience, Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
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3
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Kawabata Y, Nakajima N, Miyake H, Yamamoto Y, Toda S, Terada Y, Takahashi M, Kurimoto M. Venous Sinus Stenting for Transverse Sinus Stenosis Associated with Leptomeningeal Carcinomatosis in a Patient with Epidermal Growth Factor Receptor-Mutated Lung Cancer: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e918488. [PMID: 31929495 PMCID: PMC6979474 DOI: 10.12659/ajcr.918488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient: Male, 57-year-old Final Diagnosis: Leptomeningeal carcinomatosis Symptoms: Headache • visual acuity loss Medication: — Clinical Procedure: Venous sinus stenting Specialty: Oncology
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Affiliation(s)
- Yasuhiro Kawabata
- Department of Neurosurgery, Kyoto Katsura Hospital, Kyoto City, Kyoto, Japan
| | - Norio Nakajima
- Department of Neurosurgery, Kyoto Katsura Hospital, Kyoto City, Kyoto, Japan
| | - Hidenori Miyake
- Department of Neurosurgery, Kyoto Katsura Hospital, Kyoto City, Kyoto, Japan
| | - Yasumasa Yamamoto
- Department of Neurology, Kyoto Katsura Hospital, Kyoto City, Kyoto, Japan
| | - Shintaro Toda
- Department of Neurology, Kyoto Katsura Hospital, Kyoto City, Kyoto, Japan
| | - Yasuji Terada
- Department of Thoracic Surgery, Kyoto Katsura Hospital, Kyoto City, Kyoto, Japan
| | - Mamoru Takahashi
- Department of Thoracic Surgery, Kyoto Katsura Hospital, Kyoto City, Kyoto, Japan
| | - Masafumi Kurimoto
- Department of Ophthalmology, Kyoto Katsura Hospital, Kyoto City, Kyoto, Japan
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Lee BW, Lau FS, Francis IC. In Pseudotumor Cerebri, Hormonal Contraception is Not Associated, and the Diagnosis Remains Idiopathic Intracranial Hypertension. Am J Ophthalmol 2019; 203:116. [PMID: 31014540 DOI: 10.1016/j.ajo.2019.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
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Affiliation(s)
- Jorge C Kattah
- College of Medicine at Peoria (JCK), Illinois Neurologic Institute, University of Illinois, Peoria, IL; and Department of Neurology (GMH), Royal Prince Alfred Hospitals, Camperdown, New South Wales, Australia
| | - G Michael Halmagyi
- College of Medicine at Peoria (JCK), Illinois Neurologic Institute, University of Illinois, Peoria, IL; and Department of Neurology (GMH), Royal Prince Alfred Hospitals, Camperdown, New South Wales, Australia
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Halmagyi GM, Ahmed RM, Johnston IH. The Pseudotumor Cerebri Syndrome: A Unifying Pathophysiological Concept for Patients with Isolated Intracranial Hypertension with Neither Mass Lesion Nor Ventriculomegaly. Neuroophthalmology 2014; 38:249-253. [PMID: 27928307 DOI: 10.3109/01658107.2014.886705] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 01/13/2014] [Accepted: 01/13/2014] [Indexed: 11/13/2022] Open
Abstract
In 1991 we proposed that while the syndrome of isolated intracranial hypertension might have many definite and probable causes, it has nonetheless a single unifying pathophysiological mechanism: namely, impairment of cerebrospinal fluid (CSF) reabsorption. For that reason, we also proposed then that it is best described by a single, unifying, inclusive term, namely, pseudotumor cerebri syndrome. Although it appears that there is, as far as nomenclature is concerned, now international agreement, there is as yet no agreement on pathophysiology and classification. Herein we outline our views on these matters and give our reasons.
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Affiliation(s)
- G M Halmagyi
- Departments of Neurology; Institute of Clinical Neurosciences, University of SydneySydneyAustralia
| | - R M Ahmed
- Departments of Neurology; Institute of Clinical Neurosciences, University of SydneySydneyAustralia
| | - I H Johnston
- Neurosurgery, Royal Prince Alfred HospitalSydneyAustralia; Institute of Clinical Neurosciences, University of SydneySydneyAustralia
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