Tanrikulu Bahattin, Tuzunalp Muruvvet Ayten, Isik Ugur, Ozek M Memet
Acibadem University School of Medicine, Department of Neurosurgery, Division of Pediatric Neurosurgery, Istanbul, Türkiye.
Turk Neurosurg. 2025;35(4):618-626. doi: 10.5137/1019-5149.JTN.47309-24.3.
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).
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.
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.
Proactive ELD is an effective method to achieve a rapid decrease in ICP and retinal nerve fiber layer thickness without major complications.
确定同时使用外部腰椎引流（ELD）和口服药物是否会加速小儿特发性颅内高压（IIH）患者颅内压（ICP）的降低和视乳头水肿的消退。
在这项回顾性研究中，我们评估了接受ELD作为标准口服药物辅助治疗的IIH小儿患者的治疗结果。所有患者在ELD前后均接受眼科检查、光学相干断层扫描、视网膜神经纤维层厚度评估和ICP测量。通过系列眼科检查、光学相干断层扫描测量视网膜神经纤维层厚度以及腰椎穿刺测量ICP来评估治疗结果。
11例小儿患者（7例女性，4例男性）纳入研究。患者的平均年龄为10.9±4.4岁（范围5.6 - 17.7岁）。ELD前脑脊液初压平均为447±112.5 mm H2O。ELD后平均ICP为263.1±92.4 mm H2O。诊断时右眼和左眼视网膜神经纤维层厚度分别为200.9±113.7μm和212.6±123.3μm。ELD后，右眼和左眼厚度分别为149.4±45μm和151.4±51.3μm。ELD的平均持续时间为8.7±1.4天（范围7 - 10天）。ELD后脑脊液初压和视网膜神经纤维层厚度显著低于ELD前值。4例患者在随访期间需要行腰大池腹腔分流术。
积极进行ELD是一种有效方法，可使ICP和视网膜神经纤维层厚度迅速降低，且无重大并发症。
