67570 Optic nerve decompression (eg, incision or fenestration of optic nerve sheath)

Name of the Procedure:

Optic Nerve Decompression (commonly known as optic nerve sheath fenestration or incision/fenestration of the optic nerve sheath)

Summary

Optic nerve decompression is a surgical procedure aimed at relieving pressure on the optic nerve, which can lead to vision problems. This is often achieved by creating a small opening in the sheath surrounding the optic nerve to allow excess cerebrospinal fluid (CSF) to escape, thus reducing the pressure.

Purpose

This procedure addresses conditions causing increased CSF pressure around the optic nerve, such as idiopathic intracranial hypertension (IIH). The primary goal is to preserve or improve vision by reducing the pressure on the optic nerve.

Indications

• Progressive vision loss due to optic nerve compression.
• Severe papilledema (swelling of the optic nerve) not responding to medical treatment.
• Idiopathic intracranial hypertension (IIH) with visual symptoms.
• Conditions with elevated intracranial pressure affecting the optic nerve.

Preparation

• The patient may be required to fast (avoid eating and drinking) for several hours before the procedure.
• Adjustments to certain medications may be necessary.
• Pre-procedure diagnostic tests might include MRI, CT scans, and lumbar puncture to assess intracranial pressure and rule out other causes.

Procedure Description

1. Anesthesia: The patient is typically placed under general anesthesia.
2. Incision: A small incision is made near the outer corner of the eye to access the optic nerve.
3. Exposure: The muscles and tissues around the optic nerve are gently moved aside to expose the sheath.
4. Sheath Fenestration: A tiny opening is made in the optic nerve sheath to relieve excess pressure.
5. Closure: The incision is closed with sutures, and a bandage is applied.

Tools and equipment generally include surgical microscopes, special ophthalmic instruments, and micro-surgical tools.

Duration

The procedure typically takes about 1-2 hours.

Setting

Optic nerve decompression is performed in a hospital, usually requiring a stay in an outpatient surgical center or possibly an overnight stay for observation.

Personnel

• Ophthalmic surgeon or neurosurgeon
• Anesthesiologist
• Operating room nurses and surgical technicians

Risks and Complications

• Infection
• Bleeding
• Double vision
• Further damage to the optic nerve, possibly worsening vision
• CSF leakage
• Rarely, severe complications like brain infection (meningitis)

Benefits

• Preservation or improvement of vision.
• Relief from symptoms related to high intracranial pressure.
• Potential slowing or halting of disease progression.

Recovery

• The patient might need to stay in the hospital for a short period post-surgery for monitoring.
• Pain management and antibiotics may be prescribed.
• Avoid strenuous activity for several weeks.
• Follow-up appointments are crucial to monitor vision and healing.

Alternatives

• Medical management with medications to lower CSF pressure (e.g., acetazolamide).
• Weight loss and lifestyle modification for idiopathic intracranial hypertension.

• Other surgical options like cerebrospinal fluid shunting.

  Each alternative has its pros and cons, typically less invasive but may be less effective if the condition is severe.

Patient Experience

• During the procedure, the patient is under general anesthesia and will not feel any pain.
• Post-procedure, there may be some discomfort around the eye and mild pain, which can be managed with medication.
• Some double vision or mild vision disturbances may occur temporarily.
• A careful follow-up is essential to ensure recovery and monitor for any complications.