SURGICAL-TREATMENT OF BENIGN INTRACRANIAL HYPERTENSION - SUBTEMPORAL DECOMPRESSION REVISITED

BACKGROUND. Subtemporal decompression, first advocated by Dandy for th e treatment of benign intracranial hypertension or pseudotumor cerebri , has been replaced as a treatment mainstay by medical management usin g diuretics, steroids, and lumbar puncture. Failure of these forms of treatment has frequently led to insertion of cerebrospinal fluid shunt s. METHODS. We have retrospectively reviewed the long term outcome of eight patients who were treated by subtemporal decompression (STD) for classical presentations of refractory benign intracranial hypertensio n. The follow-up period ranged from 8 to 26 years. RESULTS. Within 1 m onth of STD, deterioration in visual fields and acuity resolved in all eight patients. Five of eight patients required CSF diversion procedu res after subtemporal decompression to control headaches. No patient e xperienced recurrent permanent visual deterioration after STD. CONCLUS ION. STD may be the most effective treatment in both long and short te rm follow-up to provide lasting relief and prevention of visual morbid ity caused by refractory benign intracranial hypertension. (C) 1998 by Elsevier Science Inc.