Nasal Endoscopic Trans‑Sphenoidal Optic Nerve Sheath Fenestration for Intractable Intracranial Hypertension with Papilloedema–Optimism with Caution

A sizeable percentage of patients with idiopathic intracranial hypertension (IIH) experience papilledema and debilitating visual loss. Medical management is not always successful, and surgical management by the traditional CSF diversion/shunting procedures is plagued with high rates of shunt blockage requiring revision procedures. Venous sinus stenting and optic nerve sheath fenestration are alternative interventions but are again associated with significant complication and revision rates. This issue reports the experience of Srivastava AK et al.,[1] with the surgical alternative of nasal endoscopic trans‐sphenoidal optic nerve sheath fenestration as an action of last resort (‘pis aller’) for patients with refractory IIH.