University of Iowa Health Care

Ophthalmology and Visual Sciences

Optic Nerve Sheath Fenestration

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This is Richard Allen at the University of Iowa.  This video demonstrates an optic nerve sheath fenestration in a patient with idiopathic intracranial hypertension. 

The approach here is the medial lid crease. 

A traction suture is placed partial thickness through the superior medial limbus with 7-0 vicryl suture to place the globe in infra and A-B duction. 

A 4-0 silk suture is then placed through the eyelid margin to provide traction. 

An incision is then made with the 15 blade at the eyelid crease through the skin and orbicularis muscle. 

The monopolar cautery is then used to further dissect through the orbicularis muscle and orbital septum until the medial and preaponeurotic fat pads are identified.

Narrow malleable retractors are then used to dissect in an inferior and medial direction between the medial and preaponeurotic fat pads to identify the optic nerve.

Neurosurgical cottonoids are used to pack around the optic nerve. 

The surgeon now switches to the operating microscope and the view is upside down. 

Meringotomy forceps are used to grasp the optic nerve sheath and straight Yasargill scissors are used to cut the optic nerve sheath and a gush of fluid is noted. 

A window of optic nerve sheath is incised with the Yasargill scissors. 

Curved Yasargill scissors are used in the final cut to direct the ends of the blades away from the nerve. 

The window of the optic nerve is removed and the area is inspected for hemostasis.

The traction sutures are removed and the skin is closed with a 6-0 Prolene suture. 

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last updated: 04/27/2015
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