Abstract TP76: Role of Surgery in Patients With Cerebral Venous Sinus Thrombosis With Visual Impairment

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Abstract

Introduction: Almost 30-70% of patients with CVT have papilledema and raised ICP majority improving with antiedema measures, but few will have progressive visual failure. The utility of CSF diversion surgeries in them is unexplored

Methods: It was a retrospective study of all patients admitted in a stroke ward with CVT confirmed on CT/MRI/MRV. These patients were treated with standard measures and in those patients with progressive visual loss an option of thecoperitoneal shunt (TPS) or optic nerve fenestration (ONF) was suggested and they underwent the procedure after informed consent.

Results: Among 350 CVT patients seen over 5 years, 8 patients had progressive visual worsening.. Mean age was 27.12+10.1 with M:F:: 3:5. Six underwent the TPS and two ONF. The presenting features were headache with papilledema with vomiting with progressive vision loss in all. Presentation was acute-4, subacute-2, and chronic-2. On imaging superior sagittal and lateral sinus was involved in all patients and deep sinuses in one. Among the two patients undergoing ONF one patient improved in vision and another patient remained status quo. None of them developed any complications of surgery. Among 6 patients who underwent TPS all of them improved in vision and it stabilised over mean follow up period of 12 months with withdrawal of the antiedema measure. Two of them developed features of excessive CSF drainage postural headache which subsided with bed rest. All the patients had non-programmable shunts.

Conclusions: Shunt surgeries especially TPS is helpful in stabilising and improving the progressive vision loss despite adequate antiedema measures in selective patients of CVT. Programmable shunts may be considered to prevent excessive CSF drainage.

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