Refractory idiopathic intracranial hypertension treated with stereotactically planned ventriculoperitoneal shunt placement

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Ventriculoperitoneal (VP) shunts have not been widely used for idiopathic intracranial hypertension (IIH) because of the difficulty of placing a shunt into normal or small-sized ventricles. The authors report their experience with stereotactic placement of VP shunts for IIH.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors reviewed the clinical records of all patients in whom stereotaxis was used to guide the placement of a VP shunt for IIH at their institution. All shunts were placed using stereotactic guidance to target the frontal horn of the lateral ventricle. Patients were contacted at a mean postoperative interval of 15.1 months. No patients were lost to follow up.</jats:p> <jats:p>The authors identified 13 patients who underwent placement of a stereotactically guided VP shunt for IIH over a 6-year period. A trial of either acetazolamide or steroid therapy had failed in all patients. Prior surgical treatments included optic nerve sheath fenestrations in seven patients and cerebrospinal fluid diversionary procedures, other than stereotactic VP shunt procedures, in nine patients. Twelve patients reported excellent or good durable symptomatic relief at the time of follow up. No patient suffered progression of visual deficits. Four patients experienced persistent headaches following the procedure. Three patients required a revision of the VP shunt for technical failure.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Stereotactically guided VP shunt placement is an effective and durable treatment option in many cases of IIH that are refractory to more traditional medical and surgical approaches.</jats:p></jats:sec>

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.…”

Visual Outcomes from Shunting for Idiopathic Intracranial Hypertension

“…Approaches include optic nerve sheath fenestration (ONSF) 8 and venous sinus stenting, 9 although the mainstay of surgical management in many centres remains shunting, usually with either a lumbo-peritoneal (LP) shunt 10 or a ventriculo-peritoneal (VP) shunt. 11 Correlating with the increasing incidence of IIH, the number of shunting procedures performed each year for IIH in the USA is increasing. 12 There have been no randomised control trials of surgical intervention in the management of this condition, with the result that the optimal surgical method of managing IIH has yet to be established, in terms of both efficacy and safety.…”

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

“…4,6,29,34 The mean age of the 31 patients was 32.4 years (range 6-63 years), and 23 (74.2%) were female. Average followup was 48.3 months (range 1-153.6 months).…”

“…21,25,40 Cerebrospinal fluid diversion procedures address the effects of IIH rather than purported causes, simply draining excess CSF out of the subarachnoid space. Such procedures include placement of LP shunts, 5,12,31 VP shunts, 6,29 and foramen magnum-atrial shunts, 22 as well as subtemporal decompressions. Optic nerve sheath decompression may work in part through CSF diversion and in part by blocking transmission of intracranial pressure to the optic disc at the level of the lamina cribrosa.…”