Lumbar Drain Placement for the Acute Treatment of Vision-Threatening Papilledema

Increased intracranial pressure (ICP) can cause vision-threatening papilledema (VTP) and swift intervention is often required to restore vision. We established a multidisciplinary protocol to streamline the admission, management, and treatment of these patients. Patients are admitted to the neuro intensive care unit for lumbar drain (LD) placement, administration of acetazolamide, and daily monitoring of visual function. LD placement is utilized to control ICP in anticipation of possible surgical intervention. Patients who do not respond to medical management undergo optic nerve sheath fenestration (ONSF) or CSF shunting procedure.