Incidence of Surgical Intervention in Pediatric Intracranial Hypertension
Hilliary E. Inger, MD; Mary Lou McGregor, MD; Catherine O. Jordan, MD; Rachel E. Reem, MD; Shawn C. Aylward, MD; Nicholas M. Scoville, BS; David L. Rogers, MD
Introduction: Optic nerve sheath fenestrations (ONSF), lumboperitoneal shunts (LPS) and ventriculoperitoneal shunts (VPS) are utilized in the management of intracranial hypertension (IH) when medical therapy is ineffective. The purpose of this study is to evaluate the incidence of surgical intervention amongst pediatric intracranial hypertension patients, and to determine if there are characteristics at presentation that predict the need for surgical intervention.
Methods: A retrospective chart review was performed on patients with primary and secondary IH from January 2010 through September 2015. Patients who underwent surgical intervention for IH (ONSF, LPS, or VPS) were identified and their presenting exam and testing data were compared to patients who were medically managed.
Results: 101 medically managed patients and 10 surgically managed patients were identified. The median ages at diagnosis were 12 and 16 years in the medically and surgically managed groups, respectively. 1.8% of patients required ONSF, 0.9% required ONSF and VPS, and 6.3% required LPS or VPS. Statistical analysis comparing body mass index (BMI, p=0.054), lumbar puncture opening pressure (LPOP, p= 0.20), gender (p= 0.29), grade of papilledema (p= 0.19), and the diagnosis of primary versus secondary IH (p= 0.17) between the two groups at presentation was not significant.
Discussion: BMI, LPOP, grade of papilledema, gender, and etiology were not predictive of the need for surgical intervention.
Conclusion: The incidence of surgical intervention for IH was 9.0%. The overall clinical course and response to treatment determined the need for surgery.