"Preventing vision loss in pediatric otogenic thrombosis: a case report highlighting surgical interventions"

Otogenic cerebral venous sinus thrombosis (CVST) is a rare complication of acute otitis media in children and may lead to severe intracranial hypertension with vision-threatening papilledema. We report the case of a 4-year-old girl with otogenic CVST involving the left transverse and sigmoid sinuses, complicated by marked intracranial hypertension and bilateral Frisén grade 4 papilledema. Serial ophthalmologic assessments and neuroimaging were performed to evaluate the response to sequential therapeutic interventions. Despite treatment with intravenous antibiotics, anticoagulation, and medical intracranial pressure-lowering therapy, papilledema and symptoms persisted. Optic nerve sheath fenestration (ONSF) resulted in partial improvement; however, subsequent temporary external lumbar drainage led to rapid and sustained resolution of papilledema, headache, and left abducens nerve palsy, with preservation of visual function. This case underscores the importance of a structured, stepwise escalation strategy incorporating both vision-directed and global intracranial pressure-lowering interventions when medical therapy alone is insufficient.