TITLE:
Cerebrospinal Fluid Diversion Procedures for Treatment of Idiopathic Intracranial Hypertension: Single Center Experience
AUTHORS:
Mahmoud M. Taha, Safwat Abouhashem, Ayman Abedelrahman
KEYWORDS:
Idiopathic Intracranial Hypertension, Lumboperitoneal Shunt, Ventriculoperitoneal Shunt, CSF, Complications
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.7 No.3,
July
17,
2017
ABSTRACT: Idiopathic intracranial hypertension (IIH) is a
disorder characterized by increased intracranial pressure without any
identifiable etiology with normal brain imaging and normal cerebrospinal fluid
(CSF) content. CSF diversion procedures are commonly used for treatment if
medical treatment failed. The aim of this study is to report our experience in
treatment of IIH with lumboperitoneal (LP) and stereotactic guided
ventriculoperitoneal (VP) shunts. The clinical data of 43 consecutive patients
with IIH refractory to medical treatment and underwent CSF diversion procedures
between 2009 and 2014 were analyzed. 29 patients underwent LP shunts and the
remaining 14 patients underwent stereotactic guided Ventricular shunts. All
patients underwent clinical, imaging and CSF manometry evaluation. 38 (88.4%) patients
were female and the remaining 5 (11.6%) patients were male. The mean age was
27.2 years. The opening pressure was above 300 mm H2O in 26 (69.8%)
patients. Headache (100%) and blurring and/or diminution of vision (81.4%) were
the commonest clinical presentation. 36 (83.7%) patients reported recovery of
their headache and 30 (69.7%) patients showed complete resolution of
papilledema. The clinical outcome between both procedures was not significant.
The incidence of perioperative complications (20.7% vs. 0%) and shunt revisions
(27.6% vs. 7.1%) were higher in patients with LP shunt than patients with
stereotactic Ventricular shunts. The results of this study demonstrate that
both LP and Ventricular shunts are valid diversion procedures for treatment of
IIH. Stereotactic guided Ventricular shunt has lower incidence of complications
and revisions and seems to be safe, effective and feasible alternative
procedure for treatment of IIH.