IIH: Optic Nerve Sheath Fenestration Versus Shunt Placement

Abstract

Idiopathic intracranial hypertension (IIH) is a condition characterized by increased intracranial pressure without a detectable cause. The main symptoms are headaches, vision loss, disc edema, double vision, and tinnitus. Risk factors include obesity, clotting disorders, and certain medications. Diagnosis is based on signs and symptoms of increased ICP with an elevated intracranial pressure, no localizing signs with the exception of abducens nerve palsy, normal CSF, and normal imaging with no intracranial mass. The best-studied medical treatment for intracranial hypertension is acetazolamide. Other medical options include furosemide. Various analgesics (painkillers) and topiramate may be used in controlling the headaches of intracranial hypertension. Based on current scientific literature, there is no clear optimal method for surgical intervention in IIH. Most studies have shown no significant difference when it comes to visual improvement, headache reduction, papilledema resolution and surgical morbidities. The choices currently lie between ONSF and CSF diversion with some variation on a shunt. Sinus stenting is achieving good results with a relatively low complication rate but there is insufficient evidence in the literature to confirm its absolute role. Management of IIH is multifactorial and aims to achieve the goal of preventing vision loss and diminishing symptoms and must be individualized to each patient.