Optical coherence tomography in pseudotumor cerebri patients with cerebral shunts (1244)

Objective: We seek to establish characteristics in patient’s receiving a cerebral shunt for pseudotumor cerebri that may be followed to predict treatment outcomes and anticipate potential shunt failures. Background: Pseudotumor cerebri is a clinical syndrome of unknown etiology, characterized by increased intracranial pressure without contributing mass or hydrocephalus. Surgery is often necessary when medical management is inadequate or visual compromise is severe, which includes cerebrospinal fluid shunting. With limited studies published on the OCT effects of shunted pseudotumor cerebri patients, we seek to retrospectively analyze our series to establish characteristics that may be followed to predict treatment outcomes and anticipate potential shunt failures. Design/Methods: Patients who received a cerebral shunting procedure for treatment of pseudotumor cerebri were reviewed in a 12 year period as an observational retrospective study. All patients with suspected papilledema received a detailed neurosurgical and ophthalmic evaluation prior to placement of the shunt procedure, with appropriate post-operative follow up. Results: Two-tailed paired t-test revealed that pre-shunt global nerve fiber thickness improved from 151.2±20.4 to 104.7±5.1 in the right eye after surgery (p=0.03). Left eye thickness improved from 129.8±12.2 to 116.2±11.2 (p=0.26). 52% of our patients had an improvement in papilledema after the shunt procedure, defined as a subjective decrease in grading based on the frisen scale. Mean deviation for automated visual field testing changed from −8.2±2.4 to −8.6±2.4 in the right eye (p=0.81), and −11.0±3.4 to −9.3±3.5 in the left (p=0.43). Subjectively, 57.1% of patients after surgery endorsed improvement in their vision. There was no significant findings based on changes in color vision, pupillary exam, intraocular pressure, and extraocular motility. Conclusions: Our study suggests improvement in optic nerve swelling after placement of a cerebral shunt for pseudotumor cerebri. With no significant difference in automated perimetry, visual field loss may be the result of irreversible optic nerve damage. Disclosure: Eric Kim has nothing to disclose. Mr. Kolli has nothing to disclose. Mr. Africk has nothing to disclose. Daniel Heiferman has nothing to disclose. The institution of Vikram Prabhu has received research support from Loyola University.