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Proactive External Lumbar Drainage Use in Pediatric Idiopathic Intracranial Hypertension and Proposal of a New
Bahattin Tanrikulu1, Mürüvvet Ayten TüZüNALP, Uğur Işık Işık
1Acibadem University School of Medicine, Department of Neurosurgery, Division of Pediatric Neurosurgery, Istanbul, Türkiye.
Insights
External lumbar drainage (ELD) combined with oral medication effectively reduces intracranial pressure (ICP) and retinal nerve fiber layer thickness in pediatric idiopathic intracranial hypertension (IIH). This proactive approach offers a safe and rapid method for managing IIH symptoms.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Neurosurgery
Background:
- Idiopathic intracranial hypertension (IIH) in children can lead to significant visual impairment.
- Elevated intracranial pressure (ICP) is a hallmark of IIH, often causing papilledema.
- Standard treatment involves oral medications, but rapid ICP reduction is crucial.
Purpose of the Study:
- To evaluate the efficacy of external lumbar drainage (ELD) as an adjunct to oral medication in pediatric IIH.
- To determine if concurrent ELD and oral medication hasten ICP decrease and papilledema resolution.
- To assess the safety and complications associated with ELD in this population.
Main Methods:
- Retrospective study of pediatric patients with IIH treated with ELD and oral medications.
- Pre- and post-ELD measurements included ophthalmological exams, optical coherence tomography (OCT) for retinal nerve fiber layer (RNFL) thickness, and ICP via lumbar puncture.
- Mean age was 10.9 years; mean ELD duration was 8.7 days.
Main Results:
- Mean ICP decreased significantly from 447 mm H2O pre-ELD to 263.1 mm H2O post-ELD.
- RNFL thickness also showed significant reduction in both eyes post-ELD.
- Four patients required lumboperitoneal shunt surgery during follow-up; no major complications reported.
Conclusions:
- Proactive external lumbar drainage is an effective adjunctive therapy for pediatric IIH.
- ELD facilitates a rapid decrease in ICP and RNFL thickness.
- This method appears safe and beneficial for managing pediatric IIH.
Aim:
To determine if the concurrent use of external lumbar drainage (ELD) and oral medication will hasten the decrease in intracranial pressure (ICP) and resolution of papilledema in pediatric idiopathic intracranial hypertension (IIH).
Material And Methods:
In this retrospective study, we evaluated the outcome of pediatric patients with IIH who underwent ELD as an adjunct treatment to standard oral medications. All patients underwent ophthalmological examination, optic coherence tomography, retinal nerve fiber layer thickness assessment, and ICP measurements before and after ELD. The outcome was evaluated via serial ophthalmological examinations, optical coherence tomography to measure retinal nerve fiber layer thickness, and lumbar puncture to measure ICP.
Results:
Eleven pediatric patients (7 females, 4 males) were enrolled in the study. The mean age of the patients was 10.9 ± 4.4 years (range, 5.6?17.7 years). The mean cerebrospinal fluid opening pressure was 447 ± 112.5 mm H2O before ELD. The mean post- ELD ICP was 263.1 ± 92.4 mm H2O. The retinal nerve fiber layer thickness at the time of diagnosis was 200.9 ± 113.7 ?m and 212.6 ± 123.3 ?m in the right and left eyes, respectively. After ELD, the thickness was 149.4 ± 45 ?m and 151.4 ± 51.3 ?m in the right and left eyes, respectively. The mean duration of ELD was 8.7 ± 1.4 days (range, 7?10 days). The post-ELD cerebrospinal fluid opening pressure and retinal nerve fiber layer thickness were significantly lower than pre-ELD values. Four patients required lumboperitoneal shunt surgery during follow-up.
Conclusion:
Proactive ELD is an effective method to achieve a rapid decrease in ICP and retinal nerve fiber layer thickness without major complications.
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