• Jillian Ploof, Shawn C Aylward, Catherine O Jordan, and Annie I Drapeau.
• Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA.
• J. Child Neurol. 2021 Oct 1; 36 (11): 1047-1053.

AimsExamine ophthalmologic outcomes and complications of lumbar drain and cerebrospinal fluid shunts in pediatric fulminant intracranial hypertension.MethodsPatients 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.ResultsFour 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.ConclusionTemporary lumbar drain with medical therapy may be a viable first approach to fulminant intracranial hypertension.

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