Treatment of increased intracranial pressure secondary to otitic hydrocephalus

Otitic hydrocephalus is defined as increased intracranial pressure secondary to acute mastoiditis with cerebral venous thrombosis, leading to visual morbidity from papilledema. As no standardized ophthalmological treatment for papilledema exists, this study aims to evaluate the impact of corticosteroids on visual and clinical outcomes.

This retrospective chart review includes children ≤18 years old, with otitic hydrocephalus and papilledema. Patients were evaluated by ophthalmology between July 2022 and July 2024 at a quaternary children's hospital. Data from ophthalmologic visits, neuroimaging, and clinical courses were recorded.

Fourteen patients [nine male (64%) and five female] were identified; their average age was 5.6 years (range 2-9). All were treated with acetazolamide, anticoagulation, and antibiotics. Two patients (14%) underwent otologic surgery and neurosurgery. Twelve patients received corticosteroids; four (29%) needed further neurosurgery, while eight (64%) improved with corticosteroids alone. Visual acuity (VA), Frisen grade at presentation, and time to corticosteroid initiation were not predictive of corticosteroid success. Patients who had corticosteroids only vs. those who had surgery had a reduced length of stay. Five patients who presented with retinal changes on optical coherence tomography developed signs of optic disc atrophy at final appointment.

This series shows that there could be a potential role for systemic corticosteroids in reducing the hospital duration of patients with otitic hydrocephalus. It demonstrates the need for close follow-up, as corticosteroid success is difficult to predict. Patients who present with retinal changes may be at higher risk for optic disc atrophy, potentially affecting visual function and requiring more frequent follow-up.