“Preventing vision loss in pediatric otogenic thrombosis: a case report highlighting surgical interventions”

TL;DR

A 4-year-old girl with severe eye pressure from a rare ear infection complication was successfully treated with a combination of surgical and medical interventions to prevent vision loss.

Contribution

This case report highlights the effectiveness of combining optic nerve sheath fenestration and external lumbar drainage in treating refractory intracranial hypertension in pediatric otogenic CVST.

Findings

Medical therapy alone failed to resolve papilledema and intracranial hypertension in a child with otogenic CVST.

Optic nerve sheath fenestration provided partial improvement, but external lumbar drainage led to rapid and sustained resolution of symptoms.

A stepwise escalation of interventions, including surgical options, is crucial when medical treatments are insufficient.

Abstract

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 Frisén 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–lowering 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–lowering interventions when medical therapy alone is insufficient.

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