External Lumbar Drainage Practice In Pediatric Pseudotumor Cerebri

Objective: Pseudotumor cerebri is defined as increased intracranial pressure(ICP) with normal radiological and cerebrospinal fluid(CSF) findings. The most frightening complication is progressive papilledema and visual loss secondary to increased ICP. First line treatment strategy is oral medications which decrease CSF production. Lumbar drainage may also be performed to obtain rapid and more sustained pressure relief in pediatric patients with very high CSF opening pressures or in patients resistant to oral medications before lumbo-peritoneal(LP) shunting decision.

Methods:Pediatric patients presenting with signs and symptoms of pseudotumor cerebri and used oral medications and lumbar drainage, between February2020–February2022 were enrolled in the study. All patients had lumbar puncture at the time of diagnosis and during further scheduled follow-up period.

Results: There were 11 patients(7female, 4male) between ages 5.6-17.7(mean10.9) years in the cohort. All patient had lumbar puncture(LP) under sedation, all of them had thorough ophthalmological evaluation including optic coherence tomography(OCT), all of them had continuous ICP monitoring during lumbar drainage period. Total follow-up period was 10.6(1.3-25.3)months. Signs and symptoms of pseudotumor cerebri completely resolved in seven patients, remaining 4 patients needed LP shunting. OCT correlated precisely with changes in ICP during follow-up. None of the patients had lumbar drainage or shunt catheter-related infection.There had been no mortality and morbidity related with treatment procedures.

Conclusion:Lumbar drainage is an effective and safe treatment option in pediatric pseudotumor cerebri patients who had extremely high and resistant ICP. It provides rapid and sustained decrease in ICP which may abolish the need for LP shunts and ophthalmological problems.