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Dados do Trabalho
Cranial morcellation decompression for refractory idiopathic intracranial hypertension in children
Primary idiopathic intracranial hypertension (PIIH) in children is rare and has a poorly understood pathophysiology.
It is characterized by raised intracranial pressure (ICP) in the absence of an identified brain lesion. Diagnosis is usually confirmed
by the measurement of a high cerebrospinal fluid (CSF) opening pressure and exclusion of secondary causes of intracranial
hypertension. Refractory PIIH may lead to severe visual impairment. The purpose of this study was to evaluate a cranial
morcellation decompression (CMD) technique as a new surgical alternative to stabilize intracranial pressure in PIIH.
Materiais e Métodos/Casuística
A literature review was carried out, disclosing only 7 pediatric cases of PIIH treated with surgical skull
expansion. In addition, we describe here one case of our own experience treated by CMD and detail the surgical technique used.
The patient’s symptoms had remarkably improved at 1- year clinical follow-up. She reported a better visual acuity and her headaches subsided; her mother also noted improvements in writing and reading skills. Objectively, her ophthalmologic examination showed normal visual fields and reduction of papilledema and macular edema at fundoscopy, and the dose of acetazolamide was progressively reduced. An adequate bony integration and cranial vault contour were achieved 6 months after surgery. Our patient had an uneventful postoperative course. She was discharged home on the fourth postoperative day.
Discussão e Conclusões
CMD surgery is a safe and effective option to control refractory PIIH in selected patients.
Idiopathic intracranial hypertension . Papilledema . Pseudotumor cerebri
Hospital das Clínicas de Ribeirão Preto - Sao Paulo - Brasil
Thiago Lyrio Teixeira, Matheus Fernando Manzolli Ballestero, Lucas Pires Augusto, Stephanie Naomi Funo de Souza, Marcelo Volpon Santos, Ricardo Santos de Oliveira