Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review

Abstract

We conclude that CSF diversion reduces visual decline and improves visual acuity. Unfortunately, headache remained in the majority of patients and low-pressure headache frequently complicated surgery. Over half of the patients required shunt revision with the majority of these requiring multiple revisions. We suggest that CSF shunting should be conducted as a last resort in those with otherwise untreatable, rapidly declining vision. Alternative treatments, such as weight reduction, may be more effective with less associated morbidity.

The diagnosis and management of idiopathic intracranial hypertension and the associated headache

“…Although appearing effective in reducing the early ICP-related signs and symptoms, complications included shunt blockage, infection, abdominal and back pain, intracranial hypotension and tonsillar herniation. Shunt revisions were required in 51% with multiple revisions needed in 30% [Sinclair et al 2011].…”

Transverse Sinus Stenting for Pseudotumor Cerebri: A Cost Comparison with CSF Shunting

“…16 As for the infection and revision rates, previous research has also reported cases of Ն10 revisions per patient in adult PTC shunt groups. 14 In contrast, the highest number of stent procedures recorded for 1 patient was 4.…”

“…12,13 The pattern of ongoing shunt complications has also been reported in adult PTC shunt groups, with similarly high revision rates of 51%-63%. 14,15 Furthermore, some "shunt-intolerant" patients can require Ն10 ventriculoperitoneal shunt revisions and Ͼ30 lumboperitoneal shunt revisions. 16 As for the infection and revision rates, previous research has also reported cases of Ն10 revisions per patient in adult PTC shunt groups.…”

“…While 10 revisions are presented as an extreme scenario, there have been reports of adult patients with PTC needing even more, which extends the increasing cost trend for patients with higher revision shunts. 14,18 Previous modeling suggests that the cost of shunting in pediatric hydrocephalus is more sensitive to the revision rate, particularly in the first year after shunting, than to the decreased infection rate or length of hospital stay. 19 Also long-term investigations of shunted children have confirmed that 81% need at least 1 revision and often several, requiring repeated procedures and hospitalizations.…”

Idiopathic Intracranial Hypertension: Diagnosis and Therapeutic Approach

“…Shunt operation does not provide remission in all patients and may cause surgical complications such as shunt dysfunction and infection. Patients who have benefited from surgery may again become symptomatic in approximately 2 years even though their shunts are functional (50,51,52). In a study by Rosenberg et al (53), the authors found that the mean time to LPe shunt revision was 9 months and that 64% of all LPe shunts were replaced within 6 months in patients with IIH.…”