Papilledema surgery
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Papilledema |
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Diagnosis |
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Treatment |
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Case Studies |
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Papilledema surgery On the Web |
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American Roentgen Ray Society Images of Papilledema surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]
Overview
Surgical treatment of papilledema depends on the underlying cause. Various surgeries including shunt surgeries, craniotomies and optic nerve sheath fenestration can be done depending on the cause.
Surgery
Shunting
It involves the placement of a ventricular catheter (a tube made ofsilastic), into the cerebral ventricles to bypass the flow obstruction/malfunctioning arachnoidal granulations and drain the excess fluid into other body cavities, from where it can be resorbed. Most shunts drain the fluid into the peritoneal cavity (ventriculo-peritoneal shunt), but alternative sites include the right atrium (ventriculo-atrial shunt), pleural cavity (ventriculo-pleural shunt), and gallbladder. There is some risk of infection being introduced into the brain through these shunts, however, and the shunts must be replaced as the person grows. More recently developed technologies using advanced imaging as well as endoscopic operative techniques have improved the ability of surgeons to place catheters in the ventricles of patients with IIH who do not have ventricular enlargement. [1]
Craniotomies
Holes are drilled in the skull to remove intracranial hematomas or relieve pressure from parts of the brain. As raised ICP's may be caused by the presence of a mass, removal of this via craniotomy will decrease raised ICP's.
Optic Nerve Sheath Fenestration
Optic nerve sheath fenestration is a procedure that is advocated for the treatment of certain types of optic nerve dysfunction associated with progressive decline in visual function. Optic nerve sheath fenestration can stabilize or improve visual loss due to papilledema in idiopathic intracranial hypertension. However, it may fail at any time after surgery. Patients with pseudotumor cerebri need to be followed up routinely with automated perimetry to detect deterioration of visual function.[2]
References
- ↑ {{cite journal |author=McGirt MJ, Woodworth G, Thomas G, Miller N, Williams M, Rigamonti D |title=Cerebrospinal fluid shunt placement for pseudotumor cerebri-associated intractable headache: predictors of treatment response and an analysis of long-term outcomes |journal=J. Neurosurg. |volume=101 |issue=4 |pages=627–32 |year=2004 |month=October |pmid=15481717 |doi=10.3171/jns.2004.101.4.0627 |url=}
- ↑ Spoor TC, McHenry JG (1993). "Long-term effectiveness of optic nerve sheath decompression for pseudotumor cerebri". Arch. Ophthalmol. 111 (5): 632–5. PMID 8489443. Unknown parameter
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