Visual Outcomes from Shunting for Idiopathic Intracranial Hypertension

Abstract

A retrospective notes review was conducted for 50 consecutive patients who underwent shunt surgery for idiopathic intracranial hypertension (IIH). The decimal visual acuity and the mean radial degrees (MRD) of the I4e isopter of the Goldmann visual field were measured pre-operatively and after a mean follow-up period of 1123 days (range: 13-3551 days). A ventriculo-peritoneal shunt was the first procedure in 38 patients and a lumbo-peritoneal shunt in 12. The mean decimal visual acuity of the worse affected eye improved from 0.75 to 0.84, p = 0.011. The MRD score of the worse affected eye improved on average from 25.6 to 35.5 , p50.0001. In those with significant pre-operative visual impairment in their worse affected eye (defined as an MRD score 30 ), the MRD score improved on average from 10.3 to 26.5 , p = 0.0008. The mean number of surgical procedures for each patient was 2.8 (range: 1-15). Taking all surgical procedures into account, post-operative complications were experienced by 30 patients. At last follow-up, 28 patients still complained of headache, 8 of whom had the intervention performed primarily for headache. Shunting can improve visual function in patients with IIH. There is significant post-operative morbidity and often the need for repeated procedures. Headache also commonly remains in these patients. There is a need for a randomised controlled trial of operative interventions in IIH. Sample size calculations for such a trial to treat significant vision loss are presented.

Diagnosis and treatment of idiopathic intracranial hypertension

“…However, it is important to stress that CSF diversion surgery is not generally a recommended treatment for headaches in the absence of visual involvement ( 26 , 27 ). A relatively large single centre retrospective study of 50 patients undergoing CSF diversion surgery for IIH describes that headache remained a problem for 56% of these patients, with 42% requiring medication for headache management post-shunt ( 32 ).…”

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

“…In earlier days also ventriculojugular and ventriculoatrial shunting have been performed. There are no prospective controlled trials to guide procedure choice but shunts with variable flow valves are reported to be superior [Hickman et al 2014].…”

Idiopathic Intracranial Hypertension: Evaluation of Admissions and Emergency Readmissions through the Hospital Episode Statistic Dataset between 2002–2020

“…Indeed, when compared to CSF shunts for all etiologies, shunts for IIH are associated with significantly higher revision rates [ 30 , 31 ]. Single-center studies report a wide range of revision rates in IIH shunts, ranging from 10% up to 60% [ 32 , 33 , 34 , 35 ]. In this study, the rising incidence of the disease and the better selection of patients for primary shunt have resulted in the reduction of patients, as a portion of the total number of IIH patients that had a shunt revision.…”