Optic nerve sheath decompression: history, techniques, and indications.

Despite skepticism regarding the efficacy of the procedure, ONSD now has an established role in the management of visual loss associated with chronic papilledema. The surgical procedure requires microscopic dissection of the intraorbital optic nerve to avoid permanent damage to the nerve and its vascular supply. Recent (albeit controversial) investigations concerning ONSD for ischemic disease of the optic nerve suggest that the procedure may have more pathophysiological effects than were once believed.