Effect of Therapeutic Lumbar Puncture on the Visual Outcome and the Further Need for Surgery in Patients with Idiopathic Intracranial Hypertension with Grade II Papilloedema
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- Category: Vol. 84, December 2016
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Effect of Therapeutic Lumbar Puncture on the Visual Outcome and the Further Need for Surgery in Patients with Idiopathic Intracranial Hypertension with Grade II Papilloedema, MOHAMED LOTFY, MOATAZ A. EL-AWADY, ASHRAF E. ZAGHLOUL and TAREK NEHAD
Abstract
Background: Idiopathic Intracranial Hypertension (IIH) is a disorder characterized by increased intracranial pressure (ICP) of unknown cause, predominantly seen in women of childbearing age and associated with a history of recent weight gain. There is little published evidence comparing lumbar puncture with medication or other treatment modalities.
Objective: To study the effect of introduction of therapeutic lumbar puncture on the visual outcome and the further need for surgery in patients with IIH (grade II papilloedema).
Patient and Methods: This prospective study included all the patients with IIH diagnosed according to the modified Dandy criteria with grade II papilloedema, managed at the Neurosurgical Department, Benha University between January 2009 and January 2014. The patients were randomly assigned into two Groups A and B according to the inclusion of thera-peutic lumbar puncture.
Results: The mean time at which headache decreased to nearly half the initial was 8.1 days (Group A) and 4.7 days (Group B). Five patients in Group A and three patients in Group B progressed to grade III papilloedema and lumbo-peritoneal CSF diversion was planned. In the first monthly-visit, 12 patients in Group A and 13 patients in Group B showed gradual improvement to grade I while 5 patients in Group A and 6 patients in Group B showed gradual improve-ment to grade 0 and at the end of follow-up period all these patients reached grade 0 papilloedema. The rate of success of treatment was 77.2% in Group A and 86.3% in Group B.
Conclusion: The results of this study favor the introduction of therapeutic lumbar CSF puncture together with the other non-surgical maneuvers in the management of IIH with grade II papilloedema.