Surgical treatment of benign intracranial hypertension--subtemporal decompression revisited.
BACKGROUND
Subtemporal decompression, first advocated by Dandy for the treatment of benign intracranial hypertension or pseudotumor cerebri, has been replaced as a treatment mainstay by medical management using diuretics, steroids, and lumbar puncture. Failure of these forms of treatment has frequently led to insertion of cerebrospinal fluid shunts.


METHODS
We have retrospectively reviewed the long term outcome of eight patients who were treated by subtemporal decompression (STD) for classical presentations of refractory benign intracranial hypertension. The follow-up period ranged from 8 to 26 years.


RESULTS
Within 1 month of STD, deterioration in visual fields and acuity resolved in all eight patients. Five of eight patients required CSF diversion procedures after subtemporal decompression to control headaches. No patient experienced recurrent permanent visual deterioration after STD.


CONCLUSIONS
STD may be the most effective treatment in both long and short term follow-up to provide lasting relief and prevention of visual morbidity caused by refractory benign intracranial hypertension.
Kessler
L A
LA
Division of Pediatric Neurosurgery, Allegheny University of the Health Sciences, Pittsburgh, Pennsylvania, USA.
Novelli
P M
PM
Reigel
D H
DH
D000293:Adolescent; D000328:Adult; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D019299:Decompression, Surgical / Q000379:methods; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity