Daniel Athavale, Alex Hamilton, Con Petsoglou,Anthony Maloof

Purpose:
To describe a novel surgical procedure forthe management of sight threatening IdiopathicIntracranial Hypertension (IIH) in a pregnant patient.

Method:
A case review is presented of a young preg-nant female with Idiopathic Intracranial Hypertensioncausing progressive visual field loss. She was intolerantto acetazolamide and required Optic Nerve SheathFenestration (ONSF). Given her pregnancy she wasnot a suitable candidate for general anaesthesia.Surgery was successfully performed under localperibulbar anaesthesia. A novel surgical techniqueusing a superomedial skin crease approach, with inser-tion of a Pediatric Molteno tube into the subarachnoidspace is presented.

Results:
Surgery was performed successfully underlocal peribulbar anaesthesia. There was demonstratedreduction of the optic disc swelling clinically and onOptical Coherence Tomography of the optic nervehead. There was also reversal of visual field loss post-operatively.

Conclusion:
Optic nerve sheath fenestration can besuccessfully performed under local anaesthesia wheregeneral anaesthesia is contraindicated. This modifiedONSF technique with insertion of Molteno has beenperformed successfully with excellent visual outcomesin six patients. This modified technique described pro-vides an alternative which may have lower rates offailure of drainage.