{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T02:38:24Z","timestamp":1792809504126,"version":"4.5.0"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Pediatric idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure despite normal cerebrospinal fluid and neuroimaging findings. Initial management is typically medical; however, nearly 10% of children will eventually require surgery for persistent headache and\/or vision loss. External lumbar drainage, which is a considerably safer treatment option, has not been adequately analyzed in children with medically refractory IIH.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors conducted a single-institution retrospective analysis of children with medically refractory IIH who had undergone external lumbar drain (ELD) placement because of worsening papilledema, reflected as increased retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT) testing. The main outcome measures were effects of external lumbar drainage on papilledema resolution, symptoms, and vision.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n The authors analyzed the medical records of 13 children with IIH (11 girls, mean age 15.0 \u00b1 2.3 years) whose mean CSF opening pressure was 45.5 \u00b1 6.8 cm H\n 2<\/jats:sub>\n O. In all children, the average global RNFL thickness in both eyes significantly increased at ELD placement (right eye 371.8 \u00b1 150.2 \u03bcm, left eye 400.3 \u00b1 96.9 \u03bcm) compared with presentation thickness (right eye 301.6 \u00b1 110.40 \u03bcm, left eye 350.2 \u00b1 107.7 \u03bcm) despite acetazolamide medical therapy (20\u201330 mg\/kg\/day), leading to ELD placement after 9.5 \u00b1 6.9 days (range 3\u201329 days). After ELD insertion, there was headache resolution, gradual and continuous improvement in optic disc thickness, and preservation of good vision.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n ELD placement in children with medically refractory IIH who demonstrated worsening papilledema with increased RNFL thickening on OCT testing typically results in symptom relief and disc edema resolution with good visual outcome, often preventing the need for additional definitive surgeries that carry greater failure and morbidity risks.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2021.2.peds2143","type":"journal-article","created":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T16:22:16Z","timestamp":1628180536000},"page":"490-496","source":"Crossref","is-referenced-by-count":8,"title":["External lumbar drainage in progressive pediatric idiopathic intracranial hypertension"],"prefix":"10.3171","volume":"28","author":[{"given":"Gad","family":"Dotan","sequence":"first","affiliation":[{"name":"Pediatric-Ophthalmology Unit, Schneider Children\u2019s Medical Center of Israel, Petah Tikva;"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Hadar Cohen","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv;"},{"name":"Ophthalmology Division, Rabin Medical Center, Petah Tikva, Israel;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanya M.","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Yale School of Medicine, Yale University, New Haven, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Shapira Rootman","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv;"},{"name":"Department of Radiology;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoram","family":"Nevo","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv;"},{"name":"Institute of Child Neurology; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Kershenovich","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Schneider Children\u2019s Medical Center of Israel, Petah Tikva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"13","key":"b1","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1212\/WNL.0b013e3182a55f17","article-title":"Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children","volume":"81","author":"Friedman DI","year":"2013","unstructured":"Friedman DI, Liu GT, Digre KB. 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