Objective: To determine the efficacy and safety of OPTIC NERVE fenestration in patient with pseudotumor cerebri with visual loss despite medical treatment. Design: Prospective; interventional case series. Patients &Methods: 13 eyes of 13 patients with PTC and visual field loss resistant to medical treatment underwent OPTIC NERVE fenestration. Visual acuity, visual field, headache, intracranial pressures were checked before and after surgery. We defined visual field stability within 2db from mean deviation. OPTIC NERVE fenestration was performed with the patient under general anesthesia. A standard transconjunctival approach was used in all cases. Results: After OPTIC NERVE fenestration visual field stabilized or improved in %85. Of 7 patients with acute papilledema, 6 patients improved, one patient worsened. Of 6 patients with chronic papilledema, 4 patients stabilized, one patient improved, one patient worsened. No significant difference was detected in MD (mean deviation) between operated eye from non operated eye after 1 week, 3 weeks, 2 months. The greatest improvement in visual field MD was detected between the first weeks to 3rd week after operation. Conclusion: OPTIC NERVE fenestration effectively stabilizes or improves visual function in the majority of patient with pseudotumor cerebri and visual loss.    

A 15-year-old boy with history of BB gun injury to his left eye was referred to our center. His visual acuity was no light perception in the left eye. Ocular findings were severe proptosis, conjunctiva injection, and conjunctival vascular tortuosity. Fundus examination revealed an extensive inferior chorioretinal scar compatible with chorioretinitis sclopetaria. A distinct bruit was detected by left orbital auscultation. Orbital and brain CT-scan showed transected OPTIC NERVE by the BB gun pellet which lodged at the left parasellar area. Cerebral angiography showed a high flow direct carotid-cavernous fistula that was successfully treated by endovascular embolization. This patient is the first reported case of concomitant carotid-cavernous fistula, OPTIC NERVE TRANSECTION, and chorioretintis sclopetaria due to BB gun injury.

In microsurgical NERVE repair, the epineural sleeve technique can be used to bridge short NERVE defects and to cover the coaptation site with the epineurium of the NERVE stump. The epineurium serves as a mechanical aid to reduce gap size, and increase repair strength, effectively assisting NERVE regeneration. This article presents a 32-year-old patient who experienced complete TRANSECTION of the median NERVE at the distal forearm, which was treated with the epineural sleeve graft reconstruction technique. NERVE regeneration was followed-up for 18 months and evaluated with the Rosé n and Lundborg scoring system. The final outcome was excellent; at the last follow-up, the patient experienced complete sensory and motor function of the median NERVE.

Traumatic OPTIC neuropathy (TON) is a rare that causes severe visual impairment usually results from cranial or ocular trauma. TON manifests directly and indirectly, which is more common. The incidence rate ranges from 0.7% to 2.5%. Clinical indicators of TON include the presence of an afferent pupillary defect after trauma, decreased vision acuity and intact ocular structure. Surgical decompression appears to be a feasible option in cases with direct bone compression on the OPTIC NERVE or progressive vision impairment in indirect TON. However, the evidence supporting treatment efficacy for improvement in vision is still ambiguous. This review will examine surgical techniques for decompressing the OPTIC canal.