Beyond idiopathic intracranial hypertension: optic nerve decompression for vision preservation in cerebrospinal fluid flow disorders. A mechanism-based approach

The authors found that optic nerve decompression guided by CSF infusion testing and orbital MRI effectively stabilizes or improves visual function in patients with CSF-related optic neuropathy, including those without elevated ICP. A mechanism-based classification into three surgical phenotypes enables individualized treatment beyond syndromic definitions. This approach may redefine surgical eligibility and expand access to vision-preserving interventions in CSF-mediated optic nerve dysfunction.