Freehand Ventriculoperitoneal Shunt for Idiopathic Intracranial Hypertension: Technical Note for Slit-Like Ventricle Puncture

Abstract

Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure, headache, and papilledema. It is frequently associated with obese women and can result in irreversible vision loss. The ventriculoperitoneal (VP) shunt has been proven to be superior to the lumboperitoneal (LP) shunt in IIH patients, with better clinical outcomes. It has been reported that the accurate placement of the ventricular catheter is highly important for shunt survival. However, a slit-like ventricle pattern, typically seen in the disease, has been considered a great concern and challenge for ventricular catheter placement, primarily for freehand technique. Frameless stereotaxy, ultrasound, and endoscopy have been described to improve the accuracy of catheter insertion. However, intraoperative image guidance is not widely accessible, especially in lower-resource countries, due to the high costs associated with its use. Techniques to improve the accuracy of the freehand VP shunt in IIH are scarce in the literature, and any effort to contribute to its development is valuable and helpful.

Navigating the Enigma: A Comprehensive Review of Idiopathic Intracranial Hypertension

“…Shunting procedures: The lumboperitoneal shunt is a first-line surgical intervention for patients diagnosed with IIH. Despite the absence of prospective randomized studies, it is frequently utilized to divert CSF and alleviate ICP [ 35 ]. This standardized protocol for shunting procedures in IIH patients aims to reduce the need for revisions within 30 days of primary shunt surgery, thereby enhancing outcomes and minimizing associated complications [ 36 ].…”