Papilledema appears a poor indicator of shunt failure in children

This prospective evaluation of all children with surgically confirmed shunt malfunction treated at one children's hospital over a nine-month period found that papilledema was not a sensitive sign of the problem, although it is a definite indication of the condition. The authors also concluded that the presence of a flat optic disk does not preclude shunt malfunction.

Four of the 29 patients included in the study (14 percent) were diagnosed with papilledema, which was identified by the study investigators by optic disk presence during dilated funduscopic examination or on RetCam photographs of disk elevation, retinal vessel obscuration, cotton wool spots or disk hemorrhages. Patient age ranged from 36 days to 18 years. Study exclusion criteria were ocular pathology unrelated to shunt malfunction, hydrocephalus or conditions preventing adequate funduscopic examination.

Intracranial pressure was measured prior to shunt repair in 19 patients. Among the 13 patients with intracranial pressure greater than 200 mm H₂O, three (23 percent) had papilledema. Five patients had flat optic disks despite intracranial pressure greater than 300 mm H₂O. The group of patients without papilledema was, on average, younger and included all 11 patients less than two years of age. Shunt failure symptom duration prior to repair was nonsignificantly longer in patients with papilledema. The authors hypothesized that papilledema development may require a critical duration of intracranial pressure elevation.