Optical coherence tomography confirms shunt malfunction and recurrence of raised intracranial pressure in optic atrophy.
Cerebrospinal fluid diversion
idiopathic intracranial hypertension
optic atrophy
optical coherence tomography
papilloedema
pseudotumour cerebri
shunts
Journal
British journal of neurosurgery
ISSN: 1360-046X
Titre abrégé: Br J Neurosurg
Pays: England
ID NLM: 8800054
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
pubmed:
7
11
2020
medline:
18
6
2022
entrez:
6
11
2020
Statut:
ppublish
Résumé
Investigating potential cerebrospinal fluid (CSF) shunt malfunction can be a challenge. Optical coherence tomography (OCT), a non-invasive imaging technique, is used to monitor changes at the optic nerve head in papilloedema. Conventional teaching suggests that in the presence of optic atrophy the optic nerve head may not re-swell in response to a relapse in raised intracranial pressure (ICP). A retrospective case series of three patients who had prior CSF diversion surgery for idiopathic intracranial cranial hypertension (IIH) is presented demonstrating the benefit of non-invasive OCT imaging confirming raised ICP. Recurrence of raised ICP, due to malfunctioning CSF shunt, was diagnosed in three patients requiring further surgical intervention. All re-presented acutely with headache and visual disturbances. All had a prior diagnosis of optic atrophy. In all patients, OCT peripapillary retinal nerve fibre layer qualitative image analysis and quantified progression analysis permitted easy detection of the recurrence of papilloedema. OCT imaging supports clinical decision making in shunt malfunction, even in the presence of established optic atrophy secondary to IIH.
Sections du résumé
BACKGROUND
UNASSIGNED
Investigating potential cerebrospinal fluid (CSF) shunt malfunction can be a challenge. Optical coherence tomography (OCT), a non-invasive imaging technique, is used to monitor changes at the optic nerve head in papilloedema. Conventional teaching suggests that in the presence of optic atrophy the optic nerve head may not re-swell in response to a relapse in raised intracranial pressure (ICP).
METHODS
UNASSIGNED
A retrospective case series of three patients who had prior CSF diversion surgery for idiopathic intracranial cranial hypertension (IIH) is presented demonstrating the benefit of non-invasive OCT imaging confirming raised ICP.
RESULTS
UNASSIGNED
Recurrence of raised ICP, due to malfunctioning CSF shunt, was diagnosed in three patients requiring further surgical intervention. All re-presented acutely with headache and visual disturbances. All had a prior diagnosis of optic atrophy. In all patients, OCT peripapillary retinal nerve fibre layer qualitative image analysis and quantified progression analysis permitted easy detection of the recurrence of papilloedema.
CONCLUSION
UNASSIGNED
OCT imaging supports clinical decision making in shunt malfunction, even in the presence of established optic atrophy secondary to IIH.
Identifiants
pubmed: 33155843
doi: 10.1080/02688697.2020.1844146
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
185-191Subventions
Organisme : Medical Research Council
ID : MR/K015184/1
Pays : United Kingdom
Organisme : Department of Health
ID : NIHR-CS-011-028
Pays : United Kingdom