Patients with novel cryptococcal meningitis, all with secondary progressive intracranial hypertension, have long been present, resulting in severe compression of the optic nerve, with only light perception or manual vision remaining and inaccurate light localization. Bilateral optic nerve sheath dissection and decompression has been performed for them. The results were excellent, with some patients having improved visual acuity, rapid disappearance of optic papillary edema, reduction of headache, decrease in intracranial pressure, and ability to discontinue hormones, mannitol, etc. Treatment of cryptococcal meningitis secondary to intracranial hypertensive compression optic neuropathy: Optic nerve sheath dissection and decompression Cryptococcal meningitis is caused by a new type of cryptococcal infection of the meninges and/or brain parenchyma. In recent years, the incidence of the disease has increased with the widespread or inappropriate use of broad-spectrum antibiotics, hormones, immunosuppressive drugs, and the increase in immunodeficiency diseases (e.g., HIV infection) and organ transplant patients. Clinical manifestations: Mostly subacute or chronic onset, a few acute onset, all age groups can develop, 20-40 years old young adults are the most common. The course of the disease is prolonged and progresses slowly. In the early stage, there is irregular hypothermia with a body temperature of 37.5-38.0℃, or mild intermittent headache, which is gradually aggravated by paroxysmal headache with nausea, frequent vomiting and other symptoms of intracranial hypertension; meningeal irritation signs: cervical tonicity, positive Kernig’s sign and Brudzinski’s sign can be seen. Some patients may develop hemiparesis, convulsions, and aphasia due to focal brain tissue damage. Progressive increase in intracranial pressure is the main cause of death and disability in these patients. Patients are often unable to survive early malignant cranial hypertension (which can be as high as 400 mmH2O or more), resulting in brain herniation and death;) About half of the patients have acute high cranial pressure on the optic nerve, resulting in bilateral optic papillary edema, rapid loss of vision and blurred vision;) If cranial hypertension persists or is progressively elevated and is not effectively controlled or relieved for a long time, it will compress the optic nerve for a long time, further leading to visual field (If cranial hypertension persists or is not effectively controlled or relieved for a long period of time, the optic nerve will be compressed for a long period of time, leading to further narrowing of the visual field and eventually blindness. Optic nerve atrophy, visual impairment or blindness are the main sequelae of novel cryptococcal meningitis. In a small number of patients, partial or complete paralysis of the auditory nerve, facial nerve, and abducent cerebral nerve by sustained intracranial hypertension, hearing loss, and limited abduction of both eyes may occur. Laboratory tests: Cerebrospinal fluid: increased pressure, slightly mixed or pale yellow in appearance. Protein content is mildly to moderately elevated. The cell count is increased, mostly around 100×106/L, with lymphocytes predominating. Chloride and glucose are mostly decreased. The diagnosis of the disease can be confirmed by direct detection of cryptococci in the ink stain of cerebrospinal fluid smear. The latex agglutination (LA) test detects the polysaccharide podocyte antigen component of Cryptococcus in the serum or cerebrospinal fluid early in the infection. This method has higher specificity and sensitivity than ink staining, and the positive rate of cerebrospinal fluid detection can be as high as 99%. If the antigen-positive titer is >1:8, the diagnosis of active cryptococcal meningitis can be confirmed. Imaging: Cranial CT lacks specificity, with 40% to 50% showing normal. The positive rate is related to the different stages of the disease, with the longer the disease course the higher the positive rate. Ventricular enlargement, hydrocephalus, meningeal enhancement and irregular large lamellar, patchy or corn-like low-density shadow in the brain parenchyma can be seen, and a few show small infarct foci or hemorrhagic foci. Cranial MRI may show round or round-like masses with low signal T1 and high signal T2 in the brain parenchyma, enlarged perivascular space, and some of them have multiple corn-like nodular changes. (Treatment options: Targeting the etiology: novel cryptococci) Treatment of systemic immune diseases and other foci of infection: such as diabetes, tinea pedis, AIDS, etc.) Systemic application of amphotericin B, fluconazole, 5-fluorocytosine and other antifungal drugs, possible disadvantages: drug toxicity, hepatic and renal impairment, single drug resistance, etc. (Intrathecal injection of amphotericin B, fluconazole, 5-fluorocytosine and other antifungal drugs, disadvantages: generally applicable to refractory patients as an alternate remedy; requires repeated injections; brain herniation, lumbar puncture operation and other complications symptomatic treatment: reduce intracranial pressure, reduce edema, alleviate symptoms) mannitol, acetazolamide and other drugs to reduce intracranial pressure, disadvantages:only for some patients have a certain effect; the magnitude of pressure reduction is not large enough; long-term use (can lead to systemic electrolyte disorders, kidney stones, etc.) Some scholars use corticosteroids, but there is controversy. Disadvantages:All the side effects of long-term use of hormones, such as centripetal obesity, hypertension, mental disorders, diabetes, etc. (Surgical treatment: reduce intracranial pressure) repeated lumbar puncture intermittently to release cerebrospinal fluid, Disadvantages: need to perform lumbar puncture repeatedly for a long time; all the possible complications of lumbar puncture. Lumbar catheter drainage, lateral ventricular drainage or ventriculoperitoneal closed shunt, disadvantages: for patients with high intracranial pressure, frequent lumbar puncture cannot effectively control the symptoms of cranial hypertension; prolonged lumbar catheter drainage with the outside world is easy to combine with bacterial infection, so the patient needs to be admitted to the intensive care unit when lumbar catheter drainage. Even if the intracranial pressure decreases, the optic nerve may not be effectively protected; a neurosurgeon is required to perform the procedure. Optic nerve sheath decompression: protects the optic nerve and is an effective method to protect the optic nerve; partially reduces the intracranial pressure and alleviates the patient’s headache and other symptoms of intracranial hypertension. Disadvantages: microsurgery is difficult and requires a specialized neuro-ophthalmologist to perform; there is a possibility of retrobulbar hemorrhage and blinding (very low chance); very few people in China have mastered this procedure.