Is it recommended to do optic nerve sheath fenestration after VP shunt surgery?

Q. Is it recommended to do optic nerve sheath fenestration after VP shunt surgery?

Answered by
Dr. Sheikh Zubair Abdul Razzak
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 18, 2018 and last reviewed on: Jul 12, 2023

Hello doctor,

My sister suffered intracranial hypertension six months back and she became blind a few weeks after. A lot was done (lumbar puncture, etc.) to bring back her vision but in vain. Recently she has had VP shunt surgery and there is another plan to do optic nerve sheath fenestration. I would like to ask you whether it is recommended to do optic nerve sheath fenestration a short time after VP shunt surgery was done. Secondly, I have attached the recent visual tests (VEP and optical coherence tomography) reports so that you can help me with interpretation.



Welcome to

I have seen the scans and the VEP (visual evoked potential) report you have sent (attachment removed to protect patient identity). In theOCT(optical coherence tomography) the optic nerve heads do seem bulged out. Was an MRI done? VP (ventriculoperitoneal) shunt surgery is done to make an alternate drainage path for the CSF (cerebrospinal fluid). An optic nerve sheath fenestration is done to relieve any pressure on the optic nerve due to the raised CSF. Your doctor must have seen some kind of a pressure build-up which could jeopardize the optic nerve further, hence he has planned the fenestration procedure.

Hi doctor,

Thank you very much for your great reply. The hospital has even taken the picture of her eye and I have attached it so as you can give us comments on how you see it. Kindly tell us your opinion about this attached picture. Until now she is still blind. I look forward to hearing from you.



Welcome back to

The picture which you have sent is of her retina and more specifically the optic nerve. The picture confirms the swelling in the optic nerve, which typically happens due to any increased pressure in the brain, in this case, intracranial hypertension. Once this pressure is relieved, by the shunt and the fenestration surgery, hopefully, the nerve should recover, unless it has been damaged severely. Anyways let’s hope for the best and god bless.

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