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Updated: Jan 28, 2026
Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Surgical intervention in pediatric intracranial hypertension: incidence, risk factors, and visual outcomes
Hilliary E Inger1, Mary Lou McGregor2, Catherine O Jordan2
1Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio; Department of Ophthalmology, The Ohio State University, Columbus, Ohio.
Insights
Pediatric intracranial hypertension (IH) surgery is uncommon, but high opening pressures on lumbar puncture predict intervention needs. Elevated BMI and papilledema grade also increase surgical likelihood in children with IH.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Ophthalmology
Background:
- Intracranial hypertension (IH) in children presents diagnostic and therapeutic challenges.
- Surgical intervention is reserved for specific cases, necessitating clear criteria for its application.
- Understanding predictors of surgical need is crucial for optimizing patient management.
Purpose of the Study:
- To determine the incidence of surgical intervention for pediatric intracranial hypertension (IH).
- To assess visual outcomes in surgically treated pediatric IH patients.
- To identify predictors associated with the need for surgical intervention in pediatric IH.
Main Methods:
- Retrospective review of medical records for pediatric patients with IH (2010-2017).
- Comparison of characteristics between medically and surgically managed patients.
- Analysis of clinical courses and outcomes for surgically managed patients.
Main Results:
- Surgical intervention rate for pediatric IH was 9.8%.
- Excellent visual acuity (20/25 or better) was achieved in most surgically treated eyes (27/28).
- Elevated BMI (OR=1.06) and lumbar puncture opening pressure ≥52 cm H2O (OR=6.17) were significant predictors for surgery; adjusted OR for high opening pressure was 4.69.
Conclusions:
- The majority of pediatric IH cases are manageable with medical treatment.
- Pediatric IH patients with lumbar puncture opening pressures ≥52 cm H2O require close monitoring due to higher surgical risk.
- Increased BMI and papilledema grade may also indicate a greater likelihood of requiring surgical intervention.
Purpose:
To evaluate the incidence of surgical intervention in pediatric intracranial hypertension (IH), evaluate the visual outcomes of surgically managed patients, and identify potential predictors for surgical intervention.
Methods:
The medical records of patients with primary and secondary IH at Nationwide Children's Hospital from 2010 to 2017 were reviewed retrospectively. Presenting characteristics of medically and surgically managed patients were compared, and the clinical courses of surgically managed patients were reviewed.
Results:
A total of 129 medically and 14 surgically managed patients were included. The surgical incidence was 9.8%. Final visual acuity in 27 of 28 surgically managed eyes was 20/25 or better. In combined primary and secondary IH patients, elevations in body mass index (BMI; OR = 1.06; 95% CI, 1.01-1.11; P = 0.022) and lumbar puncture opening pressures ≥52 cm H2O (OR = 6.17; 95% CI, 1.93-19.67; P = 0.002) were significantly associated with the likelihood of surgical intervention when assessed by univariate logistic regression; grade of papilledema >2 was of marginal significance. After controlling for BMI, a lumbar puncture opening pressure of ≥52 cm H2O was more likely to result in surgery (adjusted OR = 4.69; 95% CI = 1.39-15.98; P = 0.013).
Conclusions:
Most pediatric IH can be treated medically. Patients with lumbar puncture opening pressures ≥52 cm H2O at the time of diagnosis are at a higher risk of surgical intervention and should be monitored closely. Elevations in presenting BMI and grade of papilledema may also increase the odds of surgery.
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