Proactive External Lumbar Drainage Use in Pediatric Idiopathic Intracranial Hypertension and Proposal of a New Treatment Algorithm.

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.