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Case Series of Rapid Surgical Interventions in Fulminant Intracranial Hypertension
Jillian Ploof1, Shawn C Aylward2,3, Catherine O Jordan3,4
1Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Temporary lumbar drains may be an effective initial treatment for pediatric fulminant intracranial hypertension, leading to improved vision and resolution of symptoms. This approach, combined with medical therapy, shows promise for managing this severe condition.
Area of Science:
- Ophthalmology
- Neurology
- Pediatric Medicine
Background:
- Fulminant intracranial hypertension (FIH) in children presents a critical neurosurgical and ophthalmologic challenge.
- Effective management strategies are crucial to prevent irreversible visual impairment and neurological damage.
Purpose of the Study:
- To evaluate ophthalmologic outcomes and complications associated with lumbar drains and cerebrospinal fluid (CSF) shunts in pediatric patients with FIH.
- To compare the efficacy of temporary lumbar drains versus CSF shunts in managing FIH.
Main Methods:
- A retrospective review of patients under 21 with FIH treated with lumbar drains, CSF shunts, or both.
- Assessment of parameters including papilledema resolution, cranial nerve palsy improvement, visual acuity, visual fields, and procedural complications.
Main Results:
- All patients achieved medication freedom and resolution of papilledema and cranial nerve palsies.
- Significant improvement in visual acuity was observed in all patients, with most showing resolution of afferent pupillary defects.
- Minor visual field deficits persisted in 67% of patients; complications included one dislodged lumbar drain and two CSF shunt revisions.
Conclusions:
- Temporary lumbar drain placement, alongside medical therapy, represents a viable initial treatment for pediatric FIH.
- Both lumbar drains and CSF shunts can lead to positive ophthalmologic outcomes in managing FIH, though complications can occur.
Aims:
Examine ophthalmologic outcomes and complications of lumbar drain and cerebrospinal fluid shunts in pediatric fulminant intracranial hypertension.
Methods:
Patients under 21 years of age with a diagnosis of fulminant intracranial hypertension with temporary lumbar drain only, shunt after lumbar drain, and shunt only were included. Parameters investigated include lumbar drain data, medication freedom, time to resolution of papilledema, improvement in cranial nerve palsy, afferent pupillary defects, visual fields, visual acuity, and complications of each intervention.
Results:
Four patients had temporary lumbar drain, 2 temporary lumbar drain and cerebrospinal fluid shunt, and 3 shunt only. All achieved medication freedom and resolution of papilledema and cranial nerve palsies (if present). Most had resolution of preprocedure afferent pupillary defects. Minor residual visual field deficits occurred in 67%, and all had visual acuity improvement. One patient's lumbar drain dislodged, and one patient had 2 cerebrospinal fluid shunt revisions.
Conclusion:
Temporary lumbar drain with medical therapy may be a viable first approach to fulminant intracranial hypertension.
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