May 2005
Volume 46, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2005
The Clinical and Radiographic Spectrum of Post–Operative Optic Nerve Sheath Fenestration Pseudomeningoceles
Author Affiliations & Notes
  • E.J. Wladis
    Institute of Ophthalmology and Visual Science, UMDNJ–New Jersey Med School, Newark, NJ
  • N. Mirani
    Institute of Ophthalmology and Visual Science, UMDNJ–New Jersey Med School, Newark, NJ
  • L.P. Frohman
    Institute of Ophthalmology and Visual Science, UMDNJ–New Jersey Med School, Newark, NJ
  • P.D. Langer
    Institute of Ophthalmology and Visual Science, UMDNJ–New Jersey Med School, Newark, NJ
  • R.E. Turbin
    Institute of Ophthalmology and Visual Science, UMDNJ–New Jersey Med School, Newark, NJ
  • Footnotes
    Commercial Relationships  E.J. Wladis, None; N. Mirani, None; L.P. Frohman, None; P.D. Langer, None; R.E. Turbin, None.
  • Footnotes
    Support  Research to Prevent Blindness, NJ Lions Eye Inst, NJ Eye Institute, Gene C. Coppa Memorial Fund
Investigative Ophthalmology & Visual Science May 2005, Vol.46, 652. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      E.J. Wladis, N. Mirani, L.P. Frohman, P.D. Langer, R.E. Turbin; The Clinical and Radiographic Spectrum of Post–Operative Optic Nerve Sheath Fenestration Pseudomeningoceles . Invest. Ophthalmol. Vis. Sci. 2005;46(13):652.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract
 
Abstract:
 

To review features of optic nerve sheath pseudomeningoceles (PSM) in post–operative patients meeting the modified Dandy criteria for IIH

 

Chart review

 

1 male, 2 females (14,34,56 years old, respectively) developed radiographic evidence of post ONSF PSM on MRI scans performed 6, 6 and 11 months after ONSF, respectively. Each patient underwent ONSF via superior–medial transcutaneous orbitotomy. The first patient required concurrent medial transconjunctival approach with medial rectus disinsertion. In the first patient, the 3.6 mm ovoid cyst was poorly defined, enhanced minimally, and found during a period of post–operative stability. In the second patient, a 2 x1 x 1.5 cm tubular non–enhancing cyst compressing and displacing the globe was found in evaluation of swelling and proptosis occurring after sleeping, and the physical findings of 1mm of proptosis and mild limitation of ipsilateral supraduction. In the last patient, a 10 x 10 x 8 mm nonenhancing spherical cyst compressing the optic nerve was found in evaluation for delayed post–operative visual loss. The cyst was excised, with improvement of visual function. Histopathology showed acellular thin collagenized cystic lining consistent with a PSM. On MRI, the cysts were of low intensity on T1–weighted images and bright on T2–weighted images, and had attenuated signal on FLAIR, consistent with CSF signal characteristics. Post–contrast images revealed minimal enhancement at the ONSF site in one case.

 

After ONSF, fluid–filled cysts may form at the fistula site. These PSM likely contain CSF based on MRI appearance. Although they are difficult to distinguish from a seroma, histopathology is consistent with a PSM. They may remain clinically silent and signify a functioning ONSF, or they may cause proptosis, periorbital swelling, motility disorder, or severe visual loss. Although the incidence is unknown, clinicians should be aware of the post–operative characteristics, and consider MRI or ultrasound imaging in evaluating post–ONSF visual loss.

 

 

 
Keywords: neuro-ophthalmology: optic nerve • clinical (human) or epidemiologic studies: outcomes/complications • orbit 
×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×