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Lumboperitoneal shunt for idiopathic intracranial hypertension: patients’ selection and outcome

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Abstract

Surgical treatment of idiopathic intracranial hypertension (IIH) includes cerebrospinal fluid (CSF) diversion procedures most commonly lumboperitoneal (LP) shunt. LP shunt addresses the cause of both headache and papilledema more directly by effecting a global reduction of intracranial pressure. Twenty-two cases were included in the study. All patients underwent clinical, imaging, and CSF manometry evaluations. All patients showed failure or noncompliance to medical treatment and necessitated placement of an LP shunt. Analysis of data was conducted and evaluation of outcome was assessed. Among 22 patients who underwent LP shunt placement for IIH, 16 (72.8%) patients had severe and fulminant opening CSF pressures with values of more than 400 mmH2O. Among this group, 19 (86.4%) patients reported recovery of their headache and 16 (72.7%) patients showed complete resolution of papilledema. Shunt complications included two (9%) cases of shunt infection that required shunt extraction and antibiotic therapy, and six (27%) cases of shunt obstruction that required shunt revision. Manometric predictors for surgical treatment of IIH may include severe and fulminant opening CSF pressures as well as poor manometric response to repeated lumbar taps. Lumboperitoneal shunt is easy and effective for treating intractable headaches and visual impairment associated with IIH. Its usefulness can be optimized by meticulous technical placement of the shunt guided by rigorous protocols for shunt procedures.

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References

  1. Abu-Serieh B, Ghassempour K, Duprez T, Raftopoulos C (2007) Stereotactic ventriculoperitoneal shunting for refractory idiopathic intracranial hypertension. Neurosurgery 60:1039–1044

    Article  PubMed  Google Scholar 

  2. Banta JT, Farris BK (2000) Pseudotumor cerebri and optic nerve sheath decompression. Ophthalmology 107:1907–1912

    Article  PubMed  CAS  Google Scholar 

  3. Binder D, Horton JC, Lawton MT, McDermott MW (2004) Idiopathic intracranial hypertension. Neurosurgery 54:538–552

    Article  PubMed  Google Scholar 

  4. Bousser MG (2000) Cerebral venous thrombosis: diagnosis and management. J Neurol 247:252–258

    Article  PubMed  CAS  Google Scholar 

  5. Burgett RA, Purvin VA, Kawasaki A (1997) Lumboperitoneal shunting for pseudotumor cerebri. Neurology 49:734–739

    PubMed  CAS  Google Scholar 

  6. Cognard C, Casasco A, Toevi M et al (1998) Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow. J Neurol Neurosurg Psychiatry 65:308–316

    Article  PubMed  CAS  Google Scholar 

  7. Eggenberger ER, Miller NR, Vitale S (1996) Lumboperitoneal shunt for the treatment of pseudotumor cerebri. Neurology 46:1524–1530

    PubMed  CAS  Google Scholar 

  8. Friedman DI, Jacobson DM (2002) Views & Reviews: diagnostic criteria for idiopathic intracranial hypertension. Neurology 59:1492–1495

    PubMed  Google Scholar 

  9. Higgins JN, Cousins C, Owler BK et al (2003) Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry 12:1662–1666

    Article  Google Scholar 

  10. Johnston I, Besser M, Morgan MK (1988) Cerebrospinal fluid diversion in the treatment of benign intracranial hypertension. J Neurosurg 69:195–202

    Article  PubMed  CAS  Google Scholar 

  11. Karahalios DG, Rekate HL, Khayata MH, Apostolides PJ (1996) Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology 46:198–202

    PubMed  CAS  Google Scholar 

  12. McGirt MJ, Woodworth G, Thomas G et al (2004) Cerebrospinal fluid shunt placement for pseudotumor cerebri-associated intractable headache: predictors of treatment response and an analysis of long-term outcomes. J Neurosurg 101:627–632

    Article  PubMed  Google Scholar 

  13. Owler BK, Parker G, Halmagyi GM et al (2003) Pseudotumor cerebri syndrome: venous sinus obstruction and its treatment with stent placement. J Neurosurg 98:1045–1055

    Article  PubMed  Google Scholar 

  14. Plotnik JL, Kosmorsky GS (1993) Operative complications of optic nerve sheath decompression. Ophthalmology 100:683–690

    PubMed  CAS  Google Scholar 

  15. Rosenberg ML, Corbett JJ, Smith C et al (1993) Cerebrospinal fluid diversion procedures in pseudotumor cerebri. Neurology 43:1071–1072

    PubMed  CAS  Google Scholar 

  16. Soler D, Cox T, Bullock P, Calver DM, Robinson RO (1998) Diagnosis and management of benign intracranial hypertension. Arch Dis Child 78:89–94

    Article  PubMed  CAS  Google Scholar 

  17. Spoor TC, McHenry JG (1993) Long-term effectiveness of optic nerve sheath decompression for pseudotumor cerebri. Arch Ophthalmol 111:632–635

    Article  PubMed  CAS  Google Scholar 

  18. Sugerman HJ, DeMaria EJ, Felton WL et al (1997) Increased intra-abdominal pressure and cardiac filling pressures in obesity associated pseudotumor cerebri. Neurology 49:507–511

    PubMed  CAS  Google Scholar 

  19. Sugerman HJ, Felton WL 3rd, Sismanis A et al (1999) Gastric surgery for pseudotumor cerebri associated with severe obesity. Ann Surg 229:634–642

    Article  PubMed  CAS  Google Scholar 

  20. Sugerman HJ, Felton WL 3rd, Salvant JB Jr et al (1995) Effects of surgically induced weight loss on idiopathic intracranial hypertension in morbid obesity. Neurology 45:1655–1659

    PubMed  CAS  Google Scholar 

  21. Tulipan N, Lavin PJ, Copeland M (1998) Stereotactic ventriculoperitoneal shunt for idiopathic intracranial hypertension: technical note. Neurosurgery 43:175–177

    Article  PubMed  CAS  Google Scholar 

  22. Wang VY, Barbaro NM, Lawton MT et al (2007) Complications of lumboperitoneal shunts. Neurosurgery 60:1045–1049

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, Alexandria University, Azarita, Alexandria, Egypt

    Waleed F. El-Saadany, Ahmed Farhoud & Ihab Zidan

  2. 20 Amin Fikry St., Raml Station, Alexandria, Egypt

    Ahmed Farhoud

Authors
  1. Waleed F. El-Saadany
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  2. Ahmed Farhoud
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  3. Ihab Zidan
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Correspondence to Ahmed Farhoud.

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Comments

Dieter Hellwig, Hannover, Germany

The pathogenesis of IIH or pseudotumor cerebri is still unclear and its treatment is a challenge. Conservative therapy includes the application of acetazolamide, corticosteroids, furosemide, coproxamol, and weight reduction. Various neurosurgical approaches have been proposed and applied, including optic nerve sheath fenestration, venous sinus stenting, venous bypass surgery, and CSF diversion techniques. As the authors emphasize, it is difficult to recommend an appropriate treatment strategy since the pathophysiology of IIH is not completely understood. In the last years, the application of lumboperitoneal shunts gains importance and seems to be effective in patients with severe headache and visual impairment with the risk of loss of vision. However, shunt malfunction related to obstruction, dislocation, or infection remains a problem especially in obese patients.

The authors describe their results of 22 patients after lumboperitoneal shunt placement, where medical treatment of IIH had failed. The functional outcome of this patient group seems to be very promising. On the other hand, there was an intervention-related morbidity that should not be neglected. The main complications were shunt infection (9%) including one patient with a basal meningoencephalitis, shunt dislocation and obstruction (27%), and overdrainage (13.6%). These surgical and hardware-related problems can be solved by:

1. Reduction of operative time

2. Placement of the peritoneal catheter end in endoscopic technique to ensure that the shunt is localized deeply intraperitoneally (of course, this can be done together with an experienced abdominal surgeon, and in my experience, it is not more time consuming than the conventional technique with a mini-laparatomy in obese patients)

3. Application of a soft multicomponent catheter system that can be safely anchored to the muscular fascia

4. Insertion of a valve system together with an antisiphon device to prevent overdrainage

In conclusion, this paper is a valuable contribution to a rational surgical treatment of idiopathic intracranial hypertension. The lumboperitoneal shunt system should be applied in patients suffering from IIH when medical treatment fails.

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El-Saadany, W.F., Farhoud, A. & Zidan, I. Lumboperitoneal shunt for idiopathic intracranial hypertension: patients’ selection and outcome. Neurosurg Rev 35, 239–244 (2012). https://doi.org/10.1007/s10143-011-0350-5

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  • DOI: https://doi.org/10.1007/s10143-011-0350-5

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