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Case Series of Rapid Surgical Interventions in Fulminant Intracranial Hypertension
Journal of Child Neurology ( IF 1.9 ) Pub Date : 2021-07-14 , DOI: 10.1177/08830738211026798
Jillian Ploof 1 , Shawn C Aylward 2, 3 , Catherine O Jordan 3, 4 , Annie I Drapeau 1, 3
Affiliation  

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.



中文翻译:

暴发性颅内高压快速外科干预病例系列

目标:

检查小儿暴发性颅内高压患者腰椎引流和脑脊液分流的眼科结果和并发症。

方法:

21 岁以下诊断为暴发性颅内高压并仅进行临时腰大池引流、腰大池引流后分流和仅分流的患者均被纳入研究。调查的参数包括腰椎引流数据、药物自由度、视乳头水肿消退时间、颅神经麻痹的改善、传入性瞳孔缺陷、视野、视力和每种干预的并发症。

结果:

4例患者进行了临时腰大池引流,2例临时腰大池引流和脑脊液分流,3例仅分流。所有人都实现了药物自由和视乳头水肿和颅神经麻痹(如果存在)的解决。大多数患者的术前传入性瞳孔缺陷得到解决。67% 发生轻微残留视野缺损,所有视力均有改善。一名患者的腰椎引流管脱落,一名患者进行了 2 次脑脊液分流修复。

结论:

药物治疗的临时腰椎引流可能是治疗暴发性颅内高压的可行的首选方法。

更新日期:2021-07-14
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