Intracranial hypertensive optic papilloedema is not uncommon in the clinic, and the main causes are: idiopathic intracranial hypertension, venous sinus thrombosis, novel cryptococcal meningitis, conjunctive meningitis, etc. The impairment or loss of visual function is the main complication of such diseases. Treatment is based on the basic principle of eliminating the cause of the disease and lowering intracranial pressure, and can be divided into two categories: drug treatment (mannitol, acetazolamide, dexamethasone, etc.) and surgical treatment (repeated lumbar puncture, shunt surgery such as ventricular or lumbar pool-abdominal drainage, and optic nerve sheath opening surgery, etc.). For patients who cannot tolerate medication or for whom it is ineffective, prompt surgical treatment is required. Repeated lumbar puncture is too short-lasting and is only suitable for temporary short-term application to buy time for the patient to wait for surgery. Shunt surgery is based on the principle of lowering intracranial pressure, but it is only effective for some patients, and may have disadvantages such as tube blockage, infection, and a certain degree of disability and fatality, so some international scholars do not take it as the first-line surgical plan to save the visual function of patients with intracranial hypertensive optic papillomatous edema. Optic nerve sheath fenestration (ONSF), or optic nerve sheath incision and decompression, has been recommended by some scholars as the preferred surgical option to save visual function in these patients, especially in patients with intracranial hypertensive optic papilledema, because of its ability to effectively alleviate the headache, to save or reverse visual function, and its high surgical safety. Reports of patients with ineffective or failed shunt surgery who were still able to protect the optic nerve and improve their visual function further demonstrate the advantages of ONSF.