Clinical and Prognostic Significance of CSF Opening and Closing Pressures in Pediatric Pseudotumor Cerebri Syndrome

Publication date: Available online 30 March 2018
Source:Pediatric Neurology
Author(s): Shannon J. Beres, Claire A. Sheldon, Chantal J. Boisvert, Christina L. Szperka, Grace L. Paley, Evanette K. Burrows, Marianne R. Chilutti, Geraldine W. Liu, Shana E. McCormack, Grant T. Liu
BACKGROUNDThe purpose of this study was to determine the prognostic utility of closing pressure and volume of cerebrospinal fluid (CSF) removed with respect to papilledema resolution and headache improvement in pediatric pseudotumor cerebri syndrome (PTCS).STUDY DESIGNThis is a retrospective observational study of 93 children with definite PTCS. The primary outcome measure was time to resolution of papilledema and the secondary outcome measure was time to resolution of headache.RESULTSThere were no significant differences in gender, age, or BMI-Z observed between subjects with (N=35) and without (N=58) documented closing pressure. The median time to resolution of papilledema was not statistically different between the children above or equal to and those below the closing pressure median (170 mm of CSF, n=31, p = 0.391) or the volume of CSF removed median (16ml, n=19, p=0.155). There was no statistically significant difference detected in days of headache when comparing the children with opening pressure above and equal to the median (400 mm of CSF) from those below (n=44, p= 0.634).CONCLUSIONSNo significant association between closing pressure, or amount of CSF removed, and time to resolution of papilledema in pediatric PTCS was detected. The diagnostic and therapeutic purposes of either measuring the closing pressure or maximizing the volume of CSF removed were not evident in these analyses.



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