No Benefit for Measuring Closing Pressure in Pediatric Pseudotumor Cerebri Syndrome

cerebrospinal fluid csf
cerebrospinal fluid csf
No significant association among closing pressure, amount of CSF removed, and time to resolution of papilledema is reported in patients with PTCS.

No significant association has been demonstrated between closing pressures and high volumes of cerebrospinal fluid (CSF) removal among patients with pediatric pseudotumor cerebri syndrome (PTCS) with respect to papilledema resolution and headache improvement, according to the results of a retrospective, observational study conducted at 2 sites in the United States and published in Pediatric Neurology.

The primary outcome measure of the current study was the time to resolution of papilledema by ophthalmoscopy. This time was calculated by the number of days between the first and last dates of observed papilledema by a neuro-ophthalmologist at scheduled clinical visits. A key secondary outcome measure was the time to resolution of headache, which was calculated as the difference between the first date of headache and the last date of headache, per patent recall. Headache resolution that occurred within 10 days following lumbar puncture was considered early headache resolution.

A total of 93 children with definite PTCS were evaluated. No significant differences with respect to age, gender, or body mass index were observed between the participants with (n=35) and those without (n=58) documented closing pressures. Median time to resolution of papilledema did not differ significantly between children above or equal to and those below the median closing pressure (170 mm CSF; n=31; P =.391), nor did the volume of median CSF removed (16 mL; n=19; P =.155).

Additionally, no significant differences were reported in days of headache between those children with opening pressures above and equal to the median (400 mm CSF) and those children with opening pressures below the median (n=44; P =.634).

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The researchers concluded that there is no significant association among closing pressure, amount of CSF removed, and time to resolution of papilledema in patients with PTCS. The therapeutic and diagnostic purposes of either measuring the closing pressure or maximizing the volume of CSF removal was not apparent in these analyses. The authors noted that the elimination of these procedures from the lumbar puncture protocol for patients with PTCS might shorten the time that children are under anesthesia. Prospective studies should be conducted to build on these findings and investigate these issues further.


Beres SJ, Sheldon CA, Boisvert CJ, et al. Clinical and prognostic significance of cerebrospinal fluid opening and closing pressures in pediatric pseudotumor cerebri syndrome. Pediatr Neurol. 2018;83:50-55.