{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T06:26:34Z","timestamp":1772000794674,"version":"3.50.1"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Ophthalmol."],"abstract":"<jats:p>Otogenic cerebral venous sinus thrombosis (CVST) is a rare complication of acute otitis media in children and may lead to severe intracranial hypertension with vision-threatening papilledema. We report the case of a 4-year-old girl with otogenic CVST involving the left transverse and sigmoid sinuses, complicated by marked intracranial hypertension and bilateral Fris\u00e9n grade 4 papilledema. Serial ophthalmologic assessments and neuroimaging were performed to evaluate the response to sequential therapeutic interventions. Despite treatment with intravenous antibiotics, anticoagulation, and medical intracranial pressure\u2013lowering therapy, papilledema and symptoms persisted. Optic nerve sheath fenestration (ONSF) resulted in partial improvement; however, subsequent temporary external lumbar drainage led to rapid and sustained resolution of papilledema, headache, and left abducens nerve palsy, with preservation of visual function. This case underscores the importance of a structured, stepwise escalation strategy incorporating both vision-directed and global intracranial pressure\u2013lowering interventions when medical therapy alone is insufficient.<\/jats:p>","DOI":"10.3389\/fopht.2026.1736235","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T05:33:08Z","timestamp":1771997588000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cPreventing vision loss in pediatric otogenic thrombosis: a case report highlighting surgical interventions\u201d"],"prefix":"10.3389","volume":"6","author":[{"given":"Fatimah A.","family":"AlMuhanna","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurology, Department of Pediatrics, Prince Sultan Military Medical City","place":["Riyadh, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wejdan S.","family":"Hakami","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology, Department of Pediatrics, Prince Sultan Military Medical City","place":["Riyadh, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah M.","family":"AlHashem","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Department of Radiology, Prince Sultan Military Medical City","place":["Riyadh, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eman","family":"AlShahwan","sequence":"additional","affiliation":[{"name":"Division of Neuro-Ophthalmology, Department of Ophthalmology, Prince Sultan Military Medical City","place":["Riyadh, Saudi Arabia"]},{"name":"Department of Ophthalmology, Magrabi Health","place":["Riyadh, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yazeed A.","family":"AlHarbi","sequence":"additional","affiliation":[{"name":"Division of Neuro-Ophthalmology, Department of Ophthalmology, Prince Sultan Military Medical City","place":["Riyadh, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shatha S.","family":"AlShafi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology, Department of Pediatrics, Prince Sultan Military Medical City","place":["Riyadh, Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000002452","article-title":"Updated guidelines for the management of acute otitis media in children","volume":"38","author":"Chiappini","year":"2019","journal-title":"Pediatr Infect Dis J"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12504","article-title":"Management of paediatric otogenic cerebral venous sinus thrombosis","volume":"40","author":"Wong","year":"2015","journal-title":"Clin 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