Pseudotumor cerebri
(AKA Idiopathic Intracranial Hypertension)

Pseudotumor cerebri (SOO-doh-too-mur SER-uh-bry) occurs when the pressure inside the skull (intracranial pressure) increases for no obvious reason. The patient’s symptoms are similar to those of a brain tumor, but no tumor is present. This condition is typically seen in overweight or obese women of child-bearing years but can also be seen in males and females of all ages. The cause is poorly understood. When this condition happens, the high pressure can be diagnosed with a lumbar puncture (LP or spinal tap). Pseudotumor cerebri can cause visual problems including blindness if left untreated. Medications often can reduce this pressure, but in some cases, surgery is necessary to preserve your vision.

Symptoms of pseudotumor cerebri include symptoms that closely mimic large brain tumors: headache, nausea, vomiting, pulsating sounds within the head and vision loss. The most serious of these is damage to the optic nerve and loss of vision which can be extensive and permanent.

The procedure performed to help patients with pseudotumor cerebri and vision loss is call an optic nerve sheath fenestration. An optic nerve sheath fenestration is a procedure which involves making an opening or window in the lining of the optic nerve to allow the fluid to drain into the eye socket. This procedure may be performed through an incision in the upper eyelid or by releasing one of the eye muscles to access the optic nerve behind the eye.

The goal of optic nerve sheath fenestration is to relieve the pressure on the optic nerve to preserve a patient's vision.

The cosmetic results of this surgery are typically minimal. If an incision is made through the skin a small scar may be visible, but this generally heals very well. If an eye muscle is released to access the optic nerve, it is reattached at the conclusion of the surgery. This approach may cause double vision and a red eye, both of which are usually temporary.

Optic nerve sheath surgery is done in the operating room under general anesthesia with the patient completely asleep.
You may be willing to live with the symptoms of pseudotumor cerebri (headache, double vision, etc.) and decide not to have any surgery at this time. Oral medications frequently reduce the pressure on the optic nerves and is typically the first line therapy for pseudotumor cerebri. Other options include neurosurgery such as a lumboperitoneal (LP) shunt or ventriculoperitoneal (VP) shunt. Your doctor will refer you to a neurosurgeon if you wish to have a consult to discuss the risks and benefits of these procedures.