Pseudotumor Cerebri

Therapeutic approaches to pediatric pseudotumor cerebri: New insights from literature data

“…With regards to symptoms, dosing can be increased up to 100 mg/kg—a maximum of 2 g/day in children and 4 g/day in adolescents. 8 There is no randomized controlled trial in pediatrics, but the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) has evaluated the use of acetazolamide plus weight reduction and/or low sodium diet versus diet plus placebo in IIH patients with mild visual loss aged 18–60 years in a 12-month intervention phase and 3-year follow-up. Based on this study, acetazolamide use was consistent with improvements in papilledema and visual acuity and vision-related quality of life.…”

“…For refractory cases that do not respond to optic nerve sheath decompression, CSF shunting is the next line of treatment. 8 CSF shunting routes include lumboperitoneal shunting, ventriculoperitoneal shunting, and shunts from cisterna magna. Endoscopic optic nerve fenestration is another strategy that has been used in children, with evidence to be an effective minimally invasive procedure.…”

“…These two methods may not be comparable due to different types of patients and severity of clinical presentations in these treatments. 8 Visual outcomes after these interventions has been reviewed, yielding 49.3%, 56.6%, 67.2%, and 84.6% improvement in patients following ventriculoperitoneal shunt, lumboperitoneal shunt, optic nerve sheath fenestration, and dural venous sinus stenting, respectively, 8 even though it should be considered that CSF shunting has complications of its own: shunt obstruction, infections, need for revision, or CSF leak.…”