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. 2025 Jan;1(3):7-14.
doi: 10.71079/aside.im.1542545. Epub 2025 Apr 15.

Efficacy and Safety of Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension. A Subgroup-Focused Systematic Review and Meta-Analysis

Feras Almasoud  1 , Abduljabbar Alabduljabbar  2 , Abdulaziz Alotaibi  3 , Abdulbari Hanash  4 , Yazeed Bader Alaql  5 , Abdulwahab Alshehri  6 , Yousef Almohammadi  7 , Mohammad Alenazi  8 , Abdulmajeed Alharbi  9 , Muhammed Amir Essibayi  10   11 , David J Altschul  10   11 , Ahmed Y Azzam  10   11   12
Affiliations

Efficacy and Safety of Optic Nerve Sheath Fenestration for Idiopathic Intracranial Hypertension. A Subgroup-Focused Systematic Review and Meta-Analysis

Feras Almasoud et al. ASIDE Intern Med. 2025 Jan.

Abstract

Introduction: Optic nerve sheath fenestration (ONSF) is an important surgical management option for idiopathic intracranial hypertension (IIH) who failed medical treatment. We conducted a systematic review and meta-analysis to evaluate the outcomes of ONSF, with a focus to identify factors affecting treatment success.

Methods: A literature search was conducted up to December 2024. Primary outcomes included improvement in visual acuity, visual fields, and optic disc swelling resolution. We performed a detailed subgroup analysis based on geographic location, study design, surgical approach, and technical variations.

Results: Nineteen studies with a total of 1,159 patients were included in our study. ONSF significantly improved visual acuity in 34.5% (95% CI: 31.8-37.3%) and visual fields in 69.4% (95% CI: 65.9-72.7%) of cases. A 90.9% improvement rate was observed in reducing optic disc swelling. Significant heterogeneity was noted in visual acuity (I2=92.1%) and visual field improvements (I2=73.8%). The overall complication rate was 9% (95% CI: 5-16%). Centers that included 30 or more patients in their study demonstrated significantly lower postoperative complications.

Conclusions: ONSF demonstrates favorable efficacy in improving visual outcomes with an acceptable safety profile, lower postoperative complications were observed when the procedure was performed in high-volume centers using appropriate surgical techniques. Geographic variations and surgical approaches significantly affected outcomes, highlighting the importance of standardized protocols and adequate surgical experience. Future prospective studies with standardized outcome measures are needed to optimize patient selection and surgical techniques.

Keywords: Benign Intracranial Hypertension; Idiopathic Intracranial Hypertension; Meta-Analysis; Optic Nerve Sheath Fenestration; Systematic Review; Visual Outcomes.

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Conflict of interest statement

Conflicts of Interest: The authors declare no competing interests that could have influenced the objectivity or outcome of this research.

Figures

Figure 1:
Figure 1:
PRISMA flow chart diagram for our literature review results.
Figure 2:
Figure 2:
Overall rate of complications following ONSF Forest Plot.
See this image and copyright information in PMC

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