title: Idiopathic intracranial hypertension following spinal deformity surgery in children.
abstract: Idiopathic intracranial hypertension (IIH) after pediatric spinal deformity surgery has not been previously reported. The authors conducted a retrospective analysis of more than 1500 pediatric spinal surgeries performed between 1992 and 2011. From their analysis, they report on 3 adolescent patients who underwent uncomplicated segmental spinal instrumentation for pediatric spinal deformity correction and subsequently developed features of IIH. The common variables in these 3 patients were adolescent age, spinal deformity, being overweight, symptom onset within 2 weeks postoperatively, significant estimated blood loss, and intraoperative use of ε-aminocaproic acid (antifibrinolytic) injection. The authors postulate that the development of IIH could be the result of venous outflow obstruction due to derangement of the epidural venous plexus during surgery. The use of ε-aminocaproic acid could potentially have the risk of causing IIH, probably mediated through hyperfibrinogenemia, although there have not been published cases in the neurosurgical, orthopedic, cardiac, or general surgical literature. Idiopathic intracranial hypertension after spinal deformity correction is a condition that should be recognized by neurosurgeons and orthopedic surgeons, because appropriate intervention with early medical therapy can lead to a satisfactory clinical outcome.
authors.affiliation: Division of Pediatric Orthopedic Surgery, The Neurological Institute, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Kunes
authors.forename: George H
authors.initials: GH
authors.lastname: Thompson
authors.forename: Sunil
authors.initials: S
authors.lastname: Manjila
authors.forename: Connie
authors.initials: C
authors.lastname: Poe-Kochert
authors.forename: Alan R
authors.initials: AR
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011559:Pseudotumor Cerebri / Q000000981:diagnostic imaging* / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000601:surgery*