Lumbar peritoneal shunt in idiopathic intra cranial hypertension

Abstract

AIm: Treatment options for idiopathic intracranial hypertension (IIH) are lumbar peritoneal shunt (LP), optic nerve fenestration, ventriculoperitoneal shunt and venous stenting. We report our experience of 24 cases of LP shunt. mAterIAl and methOds: All the patients had preoperative fundus examination, cerebrospinal fluid pressure estimation and examination, visual field charting, CT scan and MR venography. Postoperative fundus examination and visual field charting was done in all cases. Follow up ranged from 18 to 137 months. results: Preoperative papilledema, headache, decreased vision, optic atrophy and diplopia were seen in 24, 24, 19, 10 and 11 patients respectively. Shunt failure, CSF leak and temporary over drainage complications in the form of headache were seen in 2, 1 and 15 cases respectively. Vision improved in 10 out of 18 patients. Only one patient, out of 9 who had only perception of light and optic atrophy preoperatively, had improved vision while all patients with vision of finger counting or better without optic atrophy improved after shunt.COnClusIOn: LP shunt is safe and effective in IIH. Results in terms of improvement in vision were better in good pre operatively vision group. yÖntem ve GereÇ: Tüm hastalara ameliyat öncesinde göz dibi muayenesi, görme alanı, beyin omurilik sıvısı basıncının ölçümü ve analizi, bilgisayarlı tomografi ve manyetik rezonans görüntüleme venografisi yapılmıştır. Ameliyat sonrası tüm hastalara gözdibi muayenesi ve görme alanı değerlendirmesi yapıldı. Hastalar 18-137 ay arasında izlendi.BulGulAr: Ameliyat öncesi dönemde papilödemi, başağrısı, görmede azalma, optik atrofi ve çift görme 24,24,19,10,11 hastada sırası ile görülmüştür. Onsekiz hastadan 10'unda görme düzelmiş. Optik atrofisi olmayan 9 hastada görme daha iyi hale gelmiş, optik atrofisi olan bir hastada ise preoperatif dönemde olan ışık algılaması daha iyi hale gelmiş. sOnuÇ: İntrakraniyal basınç artışında lumboperitoneal şant güvenli ve etkili bir yöntemdir. Ameliyat öncesi dönemde görmesi iyi olan hastaların görmesindeki düzelme daha belirgin olmaktadır.

Visual Outcomes from Shunting for Idiopathic Intracranial Hypertension

“…10,11,[18][19][20][21][22][23][24][25][26][27] There is some heterogeneity in how the results are expressed and the length of follow-up, so it is difficult to accurately compare studies. There is also heterogeneity in the type of surgical approach, be it LP or VP shunt, whether stereotactic methods were used to access the lateral ventricles or whether programmable shunts were employed.…”

Meta-Analysis of CSF Diversion Procedures and Dural Venous Sinus Stenting in the Setting of Medically Refractory Idiopathic Intracranial Hypertension

“…Seventeen studies with a CSF-diversion (On-line Table 3) 8,[40][41][42][43][44][45][46]48,[55][56][57][58][59][60] procedure meeting the inclusion criteria were analyzed, including 435 patients; 85% (310/363) were females. Sex was not reported in 3 studies (Abubaker et al, 46 Tulipan et al, 43 and Rosenberg et al 41 or 2.78 additional procedures for each failure.…”

Idiopathic intracranial hypertension: ongoing clinical challenges and future prospects

“…In terms of clinical outcomes, LPS improved headache in 71%–92% of IIH patients who experienced progressive visual loss or were not responsive to medical treatment. 84 , 88 However, recurrent headache was usually found during the follow-up period. 85 , 89 Visual acuity was improved by LPS in 42%–91% of patients.…”