CASE REPORT article
Front. Ophthalmol.
Sec. Neuro-Ophthalmology Disorders
This article is part of the Research TopicOptic Neuropathies: Etiologies, Diagnosis, and TreatmentsView all 14 articles
"Preventing Vision Loss in Pediatric Otogenic Thrombosis: A Case Report Highlighting Surgical Interventions"
Provisionally accepted
Fatimah A AlMuhanna1*
Shatha S AlShafi1Samirah A Awaji2
Abdullah M AlHashem3Yazeed A AlHarbi3
Wejdan S Hakami3- 1Prince Sultan Military Medical City, As Sulimaniyah, Saudi Arabia
- 2King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
- 3Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Otogenic cerebral venous sinus thrombosis (CVST) is a rare complication of acute otitis media in children and may lead to severe intracranial hypertension with vision-threatening papilledema. We report the case of a 4-year-old girl with otogenic CVST involving the left transverse and sigmoid sinuses, complicated by marked intracranial hypertension and bilateral Frisén grade 4 papilledema. Serial ophthalmologic assessments and neuroimaging were performed to evaluate the response to sequential therapeutic interventions. Despite treatment with intravenous antibiotics, anticoagulation, and medical intracranial pressure–lowering therapy, papilledema and symptoms persisted. Optic nerve sheath fenestration (ONSF) resulted in partial improvement; however, subsequent temporary external lumbar drainage led to rapid and sustained resolution of papilledema, headache, and left abducens nerve palsy, with preservation of visual function. This case underscores the importance of a structured, stepwise escalation strategy incorporating both vision-directed and global intracranial pressure–lowering interventions when medical therapy alone is insufficient.
Keywords: Intracranial Hypertension, lumbar drainage, Optic nerve sheath fenestration, Otogenic CVST, Pediatric papilledema
Received: 30 Oct 2025; Accepted: 26 Jan 2026.
Copyright: © 2026 AlMuhanna, AlShafi, Awaji, AlHashem, AlHarbi and Hakami. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Fatimah A AlMuhanna
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