VT163 : Creating an effective window – Medial approach to Optic nerve sheath fenestration

Dr.Ashok Kumar Grover, Dr.Shaloo Bageja, Dr.Amrita Sawhney

Progressive loss of vision caused by papilloedema in idiopathic intracranial hypertension is the commonest indication for Optic Nerve Sheath fenestration. This video presents the transconjunctival medial Orbitotomy approach to get an effective decompression.

The procedure provides an excellent access and exposure to the optic nerve. The technique comprises disinsertion of the medical rectus, effective rotation of the globe and careful retraction of orbital soft tissues with malleable retractors and cotton tipped applicators while closely watching the pupil to avoid compromising the vascular supply to the optic nerve. It is important to concentrate on the landmarks, to identify the optic nerve and avoid damage to the short ciliary vessels. The technique of excision of a quadrangular piece of dura arachnoid while the CSF egresses under pressure is highlighted. The finer points of surgical technique to achieve an effective decompression and avoid complications have been brought out.