Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension

Abstract

Object. The object of this study was to compare surgical techniques for management of visual loss in idiopathic intracranial hypertension (IIH) unresponsive to medical treatment.Methods. The published literature was reviewed using electronic and manual search techniques. Articles were categorized based upon the surgical procedure performed, including optic nerve sheath decompression (ONSD), also called optic nerve sheath fenestration; intracranial venous sinus stent placement; ventriculoperitoneal (VP) shunt placement; and lumboperitoneal (LP) shunt placement. Demographic data and visual outcome of the cumulative experience were compiled and compared for each type of surgical intervention.Results. Seventeen patients treated by stent placement, 31 by VP shunt placement, 44 by LP shunt placement, and 252 patients by ONSD were identified in the literature; average follow-up ranged from 11.8 months for patients treated with stents to 57.2 months for those treated with LP shunts. Improved or resolved vision deficit was noted in 38.7% of patients after VP shunt placement, 47% of patients after stent placement, 44.6% of patients after LP shunt placement, and 80% of eyes after ONSD. Visual worsening was rare for all procedures evaluated.Conclusions. There is a paucity of information regarding visual outcomes from intracranial venous stent placement and cerebrospinal fluid diversion procedures. Visual outcomes from ONSD are better documented and appear to be superior to other surgical techniques for management of IIH. Further studies with improved data collection regarding visual outcomes are needed for surgical procedures other than ONSD in order to assess their possible value as treatments for visual loss in IIH.

Unilateral Transverse Sinus Stenting of Patients with Idiopathic Intracranial Hypertension

“…Failure rates as high as 30% have been reported and complications are not infrequent. [50][51][52][53] Venous sinus stent placement may be an alternative treatment option for patients with IIH refractory to medical therapy. The safety and efficacy of this procedure, however, should be evaluated in a larger randomized controlled study before it is applied more widely.…”

Idiopathic Intracranial Hypertension: Diagnosis and Therapeutic Approach

“…Associating adjacent compartments surrounding the optic nerve allows local decompression of the nerve. The improvement in vision in ONSF (80%) was shown to be better compared with other methods (38.7-47%) (62). On the other hand, this method is also associated with serious complications.…”

Neurological and Ophthalmological Recovery After Lumbo-Peritoneal Shunting as a Treatment of Idiopathic Intracranial Hypertension

“…13 In our study, the twenty two patients improved gradually to be fundus free of all at four weeks post operatively. A retrospectively reviewed clinical records of eighteen patients with LPS insertion found that fourteen patients (77.8%) with preoperative headache did not complain of headache postoperatively, and four (22.2%) had headache not related to shunt function, two of the patients (11.1%) with preoperative visual complain which visual problems were reported postoperatively and thirteen patients (72.2%) did not require shunt revision so considered that LPS is effective in treatment of IIH.…”