What is optic nerve sheath fenestration?

Optic nerve sheath decompression, more commonly known as optic nerve sheath fenestration (ONSF), is a surgical procedure performed to decompress the optic nerves by creating a window in the optic nerve sheath to release CSF from the subarachnoid space around the optic nerve.

What is an optic sheath?

The optic nerve sheath refers to the three meningeal membranes—dura mater, arachnoid mater, and pia mater—that cover the optic nerve. Optic Nerve Head. The first segment of the optic nerve is the ONH (or optic disc) located at the insertion of the nerve into the eye.

What would be the correct CPT code for an optic nerve decompression of the right eye?

A. The correct Medicare coding for this case would be CPT code 67038. The air/fluid exchange and gas injection are bundled into the code. As far as the optic neurotomy is concerned, it is not billed using code 67570 (Optic nerve decompression, (eg, incision or fenestration of optic nerve sheath).

What is decompression of the optic nerve?

Endoscopic optic nerve decompression is a minimally invasive procedure used to relieve some of the pressure on the optic nerve and stabilize or improve vision by removing a portion of the bony optic canal.

Where is the optic nerve sheath?

The optic nerve sheath is a membrane covering the optic nerve behind the eye, and is continuous with the dura mater over the brain. Elevation in ICP can be transmitted through the subarachnoid space, causing extension of the space.

What causes myelinated nerve fibers in eye?

Summary. Myelinated nerve fiber layer (mNFL) is a benign clinical entity that results from an embryologic developmental anomaly whereby focal areas of the retinal nerve fiber layer fail to lose their myelin sheath. Clinically, mNFL appears as distinct white patches on the inner retinal surface.

What does IIH stand for?

Idiopathic intracranial hypertension (IIH) is a disorder related to high pressure in the brain. It causes signs and symptoms of a brain tumor. It is also sometimes called pseudotumor cerebri or benign intracranial hypertension. The fluid that surrounds the spinal cord and brain is called cerebrospinal fluid or CSF.

How is optic nerve damage treated?

Optic neuritis usually improves on its own. In some cases, steroid medications are used to reduce inflammation in the optic nerve. Possible side effects from steroid treatment include weight gain, mood changes, facial flushing, stomach upset and insomnia. Steroid treatment is usually given by vein (intravenously).

Does insurance cover orbital decompression surgery?

Orbital decompression, eye muscle surgery (strabismus surgery), and eyelid retraction surgery will usually be covered by insurance as they are performed to improve the patient’s eye and eyelid function. Upper and lower “eyelid lifts”, medically referred to as blepharoplasty, are NOT covered.

What is the efficacy of optic nerve sheath decompression for NAION?

Initial results of uncontrolled studies suggested that optic nerve sheath decompression was a promising treatment of progressive visual loss in patients with NAION. Other investigators who evaluated this surgical procedure reported varying degrees of success.

When is optic nerve decompression surgery medically necessary?

Aetna considers optic nerve decompression surgery medically necessary for the treatment of the following indications: Traumatic optic neuropathy and non-traumatic compressive optic neuropathy.

What is non-arteritic anterior ischemic optic neuropathy (NAION)?

Non-arteritic anterior ischemic optic neuropathy (NAION) is a common cause of sudden loss of vision, especially in the elderly. It is caused by infarction of the short posterior ciliary arteries supplying the anterior optic nerve. There is no direct treatment for NAION, although corticosteroids are sometimes used to reduce optic nerve edema.

Are corticosteroids an effective treatment for optic nerve injury?

Wu and co-workers (2008) stated that serious injury to the optic nerve, including direct and indirect events, induces significant visual loss and even blindness. For the past decade corticosteroids and/or optic canal decompression surgery have been widely embraced as therapeutic paradigms for the treatment of TON.