视神经鞘开窗术治疗颅内高压性视神经病变的应用进展

视神经鞘开窗术(optic nerve sheath fenestration，ONSF)，也叫视神经鞘切开减压术，最早由Wecker医生提出。它是直接切开球后视神经鞘膜，引流颅内和视神经鞘下脑脊液，降低视神经鞘内压，保护视神经的一种手术。随着手术细节的完善和器械的不断改进，该手术安全性已明显提高。过去三十多年，该手术已广泛应用于治疗各种颅内高压性视乳头水肿(包括特发性颅内高压、颅内静脉窦血栓形成继发颅内高压、隐球菌性脑膜炎继发颅内高压、颅内占位或肿瘤所致继发性颅内高压)和视功能损害。本文对其临床应用进展予以综述。本综述提示ONSF是治疗特发性颅内高压性视乳头水肿的一种良好手术选择； 对于其他各种原因所致的继发性颅内高压的患者，并发了视乳头水肿、视功能下降，若其他治疗方法不能及时保护此类患者的视功能时，应考虑实施ONSF，以尽力阻止或延缓视功能恶化。

Progress in the application of optic nerve sheath fenestration in the treatment of intracranial hypertensive optic neuropathy

Optic nerve sheath fenestration(ONSF), also known as optic nerve sheath decompression, was first proposed by Wecker. The procedure involves cutting incisions or windows in the retrabulbar optic nerve sheath to release the cerebral spinal fluid from the subarachnoid space of the optic nerve, reducing the pressure surrounding the optic nerve. With the development of surgical instruments and procedures, the safety of ONSF has been significantly improved with infrequent complications. Through the past three decades, more and more ophthalmologists realized that ONSF is an effective surgical treatment to stabilize or improve visual loss in idiopathic intracranial hypertension(IIH). Additionally, much progress in the use of ONSF has been made on secondary intracranial hypertension due to cerebral venous sinus occlusion, Cryptococcal meningitis, and intracranial mass or tumors. In this paper we review the application of ONSF in IIH, and secondary intracranial hypertension. From the review, it indicates ONSF is a good surgical alternative for ophthalmologists. It also indicates that ONSF can be used to prevent or halt progressive visual loss associated with intracranial hypertension, particularly when other treatment modalities fail to protect vision.