Shunting a more frequent treatment than ONSF for pseudotumor cerebri syndrome: JAMA

USA: Shunting is used more frequently than optic nerve sheath fenestration (ONSF) for treatment of pseudotumor cerebri syndrome (PTCS), suggests a recent study in JAMA Network Open.

The findings reflect underlying trends in medical treatment practices and outcomes or growing limitations in access to ophthalmic surgical expertise.

Optic nerve sheath fenestration  and cerebrospinal fluid shunting are used sometimes for the treatment of pseudotumor cerebri syndrome but their use patterns are not known. To fill this knowledge gap, Ali G. Hamedani, University of Pennsylvania, Philadelphia, and colleagues aimed to investigate the frequency of surgical PTCS treatment in the United States and to compare patients undergoing ONSF with those treated with shunting.

For the purpose, the researchers set up a retrospective longitudinal cross-sectional study. They obtained inpatient data from the National Inpatient Sample (NIS), and outpatient surgical center data from the National Survey of Ambulatory Surgery (NSAS) and National Hospital Ambulatory Medical Care Survey (NHAMCS).

The analysis included 10 720 patients (18 to 65 years) with a diagnosis code for PTCS. Patients with venous thrombosis and intracranial hypertension were excluded. Time trends were explored and logistic regression was used to measure differences according to age, race/ethnicity, sex, Elixhauser comorbidity index, and other patient and hospital characteristics. Data analysis was performed from March 31 to October 7, 2020.