Journal of American Association for Pediatric Ophthalmology and Strabismus
Major articleSensitivity of papilledema as a sign of shunt failure in children
Section snippets
Methods
This study was approved by the Institutional Review Board at the University of Arkansas for Medical Sciences and conformed to the requirements of the United States Health Insurance Portability and Privacy Act.
All children with surgically confirmed shunt malfunction at Arkansas Children's Hospital, Little Rock, Arkansas, between July 2007 and April 2008 were prospectively analyzed. Although there was no specific upper age limit for inclusion in this study, patients at Arkansas Children's
Results
There were a total of 35 patients with surgically confirmed shunt failure. Two patients were excluded from analysis because of the presence of an intracranial tumor (1 patient) and microphthalmos (1 patient). Of the remaining 33 patients, 4 patients did not receive an eye examination because a study physician was not available at the time of surgical shunt repair.
Data from the remaining 29 patients was then compiled for analysis. The patients ranged in age from 36 days to 18 years. There were
Discussion
Our study shows that papilledema is not a sensitive sign of shunt failure. Even children with elevated intracranial pressure from shunt malfunction often have flat optic disks. We are not suggesting that papilledema is not an important finding in patients with shunts. Indeed, several investigators have described patients in whom papilledema was the only sign of shunt failure.3, 4 These studies show that children with shunts and papilledema should be considered to have shunt malfunction, even in
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Cited by (48)
Escape from prism
2023, Survey of OphthalmologyCitation Excerpt :The demonstrated lack of correlation between opening pressure on lumbar puncture and ICP monitoring emphasizes the need for direct ICP monitoring in patients suspected to have elevated ICP despite normal lumbar punctures.16 Because papilledema takes time to develop, it is a relatively insensitive sign of acute shunt malfunction.12 In our case the clinical symptomatology and MRI finding of flattening of the posterior sclera providing clues to the underlying diagnosis of elevated ICP due to shunt malfunction.2
OS reboot
2022, Survey of OphthalmologyCitation Excerpt :A study in humans examining acute rises in ICP after spontaneous hemorrhage or craniocerebral trauma showed that patients with mild increases in ICP (20-30 mm Hg) did not develop optic disc edema and that the development of papilledema was rare even in patients with significant ICP elevations (30-70 mm Hg) for at least 3 consecutive days.35 Even in children with surgically confirmed shunt failure and severe elevations in ICP, only 14% had developed papilledema in one study, again underscoring its inadequacy as a sign of shunt failure.29 Resolution of papilledema after normalization of ICP may also take weeks to months.26
Craniosynostosis: Posterior Cranial Vault Remodeling
2021, Clinics in Plastic SurgeryCitation Excerpt :Completion of PVDO results in an improvement or resolution of elevated ICP.39,59 Outcomes used to determine resolution (eg, fundoscopy), however, have a low sensitivity (11%–40%) compared with the gold standard direct ICP measurements.60–62 Optical coherence tomography was recently validated for detecting elevated ICP in patients with CS, with greater specificity (89%).63
Shunt Placement and Management
2018, Neurocritical Care Management of the Neurosurgical Patient
Supported in part by an unrestricted grant from Research to Prevent Blindness (New York, NY) and the Pat & Willard Walker Eye Research Center, Jones Eye Institute, University of Arkansas for Medical Sciences (Little Rock, AR).