الفهرس 
Anatomy and physiological considerationsOnly 14 pages are availabe for public view
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Abstract
Pseudotumor cerebri IS a disease condition in which the ICP is increased for
reasons that are not clear.
The main impact of pseudotumor cerebri is on the optic nerves and
consequently , the visual function. Once diagnosed , patient with pseudotumor
cerebri should be investigated and treated vigorously before visual functions are
irreversibly compromised.
Every patient should be submitted to adequate history taking including queries
about age, sex, onset of symptoms, nature of visual and general complaints, history of
drug intake and history of previous treatment of pseudotumor cerebri.
Considering the visual complaints these patients are usually complaining from
blurred vision, recurrent attacks of visual loss or binocular diplopia. Headache is a
very common complaint. Some patients may complaing from tinnitus.
Patients should be submitted to thorough neurological examination, general
investigations, central nervous system imaging by CT scan and lumbar puncture to
obtain CSF sample for cytologic analysis and to measure the CSF opening pressure.
CSF opening pressure may be found to be higher than its normal values in
most of these patients.
Every patient should be subjected to ophthalmolgical examination including
anterior segment examination, examination of the pupillary reaction, examination of
ocular motility, fundus examination with staging of the present papilledema, visual
acuity testing and visual field examination. Fundus photography should be done for
every patient.
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On examination we may find enlargement of the blind spot. field constriction.
diminution of vision, lateral rectus palsy or afferent pupillary defect.
Fundus examination usually shows bilateral papilledema • the papilledema
may be early • chronic or chronic atrophic. Also asymmetric papilledema may be
found.
Once visual function loss is detected. the patient should receive intense course
of medical therapy, many drugs have been tried, non of them proved to be ideal.
Patient under medical treatment should be followed-up closely to judge the
success of therapy and to detect the occurance of any major adverse reaction from the
received medications.
Patient with pseudotumor cerebri is highly indicated for surgery if he or she
develops any visual function deterioration inspite of being under medical therapy.
This deterioration is in the form of DROP of visual acuity appearance of new field
detect • enlargement of preexisting field loss • or increasing of the RAPD.
Additionaly , failure of medical treatment to restore the lost visual function is an
indication for surgery.
ONSD is performed using transconjunctival medial orbitotomy approach to
expose the intraorbital retrobulbar optic nerve. This is followed by excision of a
window from the optic nerve sheath or incision of the optic nerve sheath. CSF is
usually observed to gush from the subarochnoid space around the optic nerve.
These patients should be followed up for at least six months where they are
tested for visual acuity , fiel~ of vision and fundus photography should be done. Also
these patients are asked about the amelioration of headache , blurred vision and
tinnitus. Many studies proved the success of this modality of surgical treatment to
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improve papilledema and visual function. The improvement is better when ONSD is
done early and before atrophy of the optic nerve. When optic atrophy occurs ONSD
should be done rapidly. The appearance of optic atrophy does not preclude the
improvement of vision.
According to many studies the lack of complication and the ease of the
operation together with the encouraging results make ONSD the surgical treatment of
choice by many workers when they resorte to surgery for treating patients having
pseudotumor cerebri.