Clinical and Prognostic Significance of Cerebrospinal Fluid Opening and Closing Pressures in Pediatric Pseudotumor Cerebri Syndrome

• Published in: Pediatric neurology 2018-06, Vol.83, p.50-55
• Main Authors: Beres, Shannon J., Sheldon, Claire A., Boisvert, Chantal J., Szperka, Christina L., Paley, Grace L., Burrows, Evanette K., Chilutti, Marianne R., Liu, Geraldine W., McCormack, Shana E., Liu, Grant T.
• Format: Article
• Language: English
• Subjects: Adolescent; Cerebrospinal Fluid Pressure; Child; Child, Preschool; Children; Closing pressure; Female; Headache; Headache - etiology; Headache - surgery; Humans; Idiopathic intracranial hypertension; Male; Neurosurgical Procedures; Opening pressure; Outcome Assessment, Health Care; Papilledema; Papilledema - etiology; Papilledema - surgery; Prognosis; Pseudotumor cerebri; Pseudotumor Cerebri - complications; Pseudotumor Cerebri - physiopathology; Pseudotumor Cerebri - surgery; Retrospective Studies; Time Factors
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2018.02.011

The purpose of this study was to determine the prognostic utility of closing pressure and volume of cerebrospinal fluid removed with respect to papilledema resolution and headache improvement in pediatric pseudotumor cerebri syndrome. This is a retrospective observational study of 93 children with definite pseudotumor cerebri syndrome. The primary outcome measure was time to resolution of papilledema, and the secondary outcome measure was time to resolution of headache. There were no significant differences in gender, age, or body mass index z score observed between subjects with (N = 35) and without (N = 58) documented closing pressure. The median time to resolution of papilledema was not statistically different between children above or equal to and those below the median closing pressure (170 mm of cerebrospinal fluid, n = 31, P = 0.391) or the volume of median cerebrospinal fluid removed (16 mL, n = 19, P = 0.155). There was no statistically significant difference detected in days of headache between the children with opening pressure above and equal to the median (400 mm of cerebrospinal fluid) and the children with opening pressure below the median (n = 44, P = 0.634). No significant association between closing pressure, amount of cerebrospinal fluid removed, and time to resolution of papilledema due to pseudotumor cerebri syndrome was detected. The diagnostic and therapeutic purposes of either measuring the closing pressure or maximizing the volume of cerebrospinal fluid removed were not evident in these analyses.