Optical coherence tomography confirms shunt malfunction and recurrence of raised intracranial pressure in optic atrophy

Abstract

Background

Investigating potential cerebrospinal fluid (CSF) shunt malfunction can be a challenge. Optical coherence tomography (OCT), a non-invasive imaging technique, is used to monitor changes at the optic nerve head in papilloedema. Conventional teaching suggests that in the presence of optic atrophy the optic nerve head may not re-swell in response to a relapse in raised intracranial pressure (ICP).

Methods

A retrospective case series of three patients who had prior CSF diversion surgery for idiopathic intracranial cranial hypertension (IIH) is presented demonstrating the benefit of non-invasive OCT imaging confirming raised ICP.

Results

Recurrence of raised ICP, due to malfunctioning CSF shunt, was diagnosed in three patients requiring further surgical intervention. All re-presented acutely with headache and visual disturbances. All had a prior diagnosis of optic atrophy. In all patients, OCT peripapillary retinal nerve fibre layer qualitative image analysis and quantified progression analysis permitted easy detection of the recurrence of papilloedema.

Conclusion

OCT imaging supports clinical decision making in shunt malfunction, even in the presence of established optic atrophy secondary to IIH.

Keywords:

• Cerebrospinal fluid diversion
• idiopathic intracranial hypertension
• optic atrophy
• optical coherence tomography
• papilloedema
• pseudotumour cerebri
• shunts

Consent

We confirm that patients described in your paper have given written consent to the inclusion of material pertaining to themselves, cannot be identified by the information, and that we have fully anonymized them.

Disclosure statement

SPM - Invex therapeutics advisory board (2019); Heidelberg engineering speaker fees (2019).

AJS - Invex therapeutics, company director with salary and stock options (2019, 2020).

None of the other authors have a conflict of interest in the subject matter.

Authors contribution

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Additional information

Funding

No funding or sponsorship was received for this study or publication of this article. AJS is funded by a Sir Jules Thorn Award for Biomedical Science.