Cerebrospinal Fluid Diversion Procedures for Treatment of Idiopathic Intracranial Hypertension: Single Center Experience

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DOI: 10.4236/ojmn.2017.73009    46 Downloads   95 Views  

ABSTRACT

Idiopathic intracranial hypertension (IIH) is a disorder characterized by increased intracranial pressure without any identifiable etiology with normal brain imaging and normal cerebrospinal fluid (CSF) content. CSF diversion procedures are commonly used for treatment if medical treatment failed. The aim of this study is to report our experience in treatment of IIH with lumboperitoneal (LP) and stereotactic guided ventriculoperitoneal (VP) shunts. The clinical data of 43 consecutive patients with IIH refractory to medical treatment and underwent CSF diversion procedures between 2009 and 2014 were analyzed. 29 patients underwent LP shunts and the remaining 14 patients underwent stereotactic guided Ventricular shunts. All patients underwent clinical, imaging and CSF manometry evaluation. 38 (88.4%) patients were female and the remaining 5 (11.6%) patients were male. The mean age was 27.2 years. The opening pressure was above 300 mm H2O in 26 (69.8%) patients. Headache (100%) and blurring and/or diminution of vision (81.4%) were the commonest clinical presentation. 36 (83.7%) patients reported recovery of their headache and 30 (69.7%) patients showed complete resolution of papilledema. The clinical outcome between both procedures was not significant. The incidence of perioperative complications (20.7% vs. 0%) and shunt revisions (27.6% vs. 7.1%) were higher in patients with LP shunt than patients with stereotactic Ventricular shunts. The results of this study demonstrate that both LP and Ventricular shunts are valid diversion procedures for treatment of IIH. Stereotactic guided Ventricular shunt has lower incidence of complications and revisions and seems to be safe, effective and feasible alternative procedure for treatment of IIH.

Cite this paper

Taha, M. , Abouhashem, S. and Abedelrahman, A. (2017) Cerebrospinal Fluid Diversion Procedures for Treatment of Idiopathic Intracranial Hypertension: Single Center Experience. Open Journal of Modern Neurosurgery, 7, 75-86. doi: 10.4236/ojmn.2017.73009.

References

[1] Almarzouqi, S., Morgan, M.L. and Lee, A.G. (2015) Idiopathic Intracranial Hypertension in the Middle East: A Growing Concern. Saudi Journal of Opthalmology, 29, 26-31.
https://doi.org/10.1016/j.sjopt.2014.09.013
[2] El-Saadany, W.F., Farhoud, A. and Zidan, I. (2012) Lumboperitoneal Shunt for Idiopathic Intracranial Hypertension: Patients Selection and Outcome. Neurosurgical Review, 35, 239-244.
https://doi.org/10.1007/s10143-011-0350-5
[3] Durcan, F.J., Corbett, J.J. and Wall, M. (1988) The Incidence of Pseudotumor Cerebri. Population Studies in Iowa and Louisiana. Archives of Neurology, 45, 875-877.
https://doi.org/10.1001/archneur.1988.00520320065016
[4] Ibrahim, Y.A., Mironov, O., Deif, A., Mangla, R. and Almast, J. (2014) Idiopathic Intracranial Hypertension: Diagnostic Accuracy of the Transverse Dural Venous Sinus Attenuation on CT Scans. The Neuroradiology Journal, 27, 665-670.
https://doi.org/10.15274/nrj-2014-10086
[5] Wall, M. (1991) Idiopathic Intracranial Hypertension. Neurologic Clinics, 9, 73-95.
[6] Alsuhaibani, A.H., Carter, K.D., Nerad, J.A. and Lee, A.C. (2011) Effect of Optic Nerve Sheath Fenestration on Papilledema of the Operated and the Contralateral Non Operated Eyes in Idiopathic Intracranial Hypertension. Ophthalmology, 118, 412-414.
https://doi.org/10.1016/j.ophtha.2010.06.025
[7] Bono, F., Giliberto, C., Mastrandrea, C., Cristiano, D., Lavano, A., Fera, F., et al. (2005) Transverse Sinus Stenosis Persist after Normalization of the CSF Pressure in Idiopathic Intracranial Hypertension. Neurology, 65, 1090-1093.
https://doi.org/10.1212/01.wnl.0000178889.63571.e5
[8] McGirt, M.J., Woodworth, G., Thomas, G., Miller, N., Williams, M. and Rigamonti, D. (2004) Cerebrospinal Fluid Shunt Placement for Pseudotumor Cerebri-Associated Intractable Headache: Predictors of Treatment Response and an Analysis of Long-Term Outcome. Journal of Neurosurgery, 101, 627-632.
https://doi.org/10.3171/jns.2004.101.4.0627
[9] Moran, D., Kosztowski, T.A., Jusué-Torres, Orkoulas-Razis, D., Ward, D., Carson, K., Hoffberger, J., Elder, B.D., Goodwin, C.R. and Rigamonti, D. (2015) Does CT Wand Guidance Improve Shunt Placement in Patients with Hydrocephalus. Clinical Neurology and Neurosurgery, 132, 26-30.
https://doi.org/10.1016/j.clineuro.2015.02.007
[10] Aboubaker, K., Ali, Z., Raza, K., Bolger, C., Rawluk, D. and O’Brien, D. (2011) Idiopathic Intracranial Hypertension: Lumpoperitoneal Shunts versus Ventriculoperitoneal Shunts—Case Series and Literature Review. British Journal of Neurosurgery, 25, 94-99.
https://doi.org/10.3109/02688697.2010.544781
[11] Kandasamy, J., Hayhurst, C., Clark, S., Jenkinson, M.D., Byrne, P., Karabatsou, K. and Mallucci, C.L. (2011) Electromagnetic Stereotactic Ventriculoperitoneal CSF Shunting for Idiopathic Intracranial Hypertension: A Successful Step Forward? World Neurosurgery, 75, 155-160.
https://doi.org/10.1016/j.wneu.2010.10.025
[12] Puffer, R.C., Mustafa, W. and Lanzino, G. (2013) Venous Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of the Literature. Journal of NeuroInterventional Surgery, 5, 483-486.
https://doi.org/10.1136/neurintsurg-2012-010468
[13] Liao, Y.J., Dillon, W.P., Chin, C.T., McDermott, M.W. and Horton, J.C. (2007) Intracranial Hypotension Caused by Leakage of Cerebrospinal Fluid from the Thecal Sac after Lumboperitoneal Shunt Placement. Case Report. Journal of Neurosurgery, 107, 173-177.
https://doi.org/10.3171/JNS-07/07/0173
[14] Basaran, R., Efendioglu, M., Bolukbasi, F.H., Aslan, S., Isik, N. and Kaner, T. (2014) Spinal Intradural Hematoma and Permanent Paraparesis after a Lumboperitoneal Shunt Operation: An Unusual Complication. Asian Spine Journal, 8, 516-520.
https://doi.org/10.4184/asj.2014.8.4.516
[15] Woodworth, G.F., McGirt, M.J., Elfert, P., Sciubba, D.M. and Rigamonti, D. (2005) Framless Stereotactic Ventricular Shunt Placement for Idiopathic Intracranial Hypertension. Stereotactic and Functional Neurosurgery, 83, 12-16.
https://doi.org/10.1159/000084059
[16] Sinclair, A.J., Kuruvath, S., Sen, D., Nightingale, P.G., Burdon, M.A. and Flint, G. (2011) Is Cerebrospinal Fluid Shunting in Idiopathic Intracranial Hypertension Worthwhile? A 10-Year Experience. Cephalgia, 31, 1627-1633.
https://doi.org/10.1177/0333102411423305
[17] Niotakis, G., Grigoratos, D., Chandler, C., Morrison, D. and Lim, M. (2013) CSF Diversion in Refractory Idiopathic Intracranial Hypertension: Single-Center Experience and Review of Efficacy. Child’s Nervous System, 29, 263-267.
[18] Tarnaris, A., Toma, A.K., Watkins, L.D. and Kitchen, N.D. (2011) Is There a Difference in Outcomes of Patients with Idiopathic Intracranial Hypertension with the Choice of Cerebrospinal Fluid Diversion Site: A Single Center Experience. Clinical Neurology and Neurosurgery, 113, 477-479.
https://doi.org/10.1016/j.clineuro.2011.02.008
[19] Menger, R.P., Connor Jr., D.E., Thakur, J.D., Sonig, A., Smith, E., Guthikonda, B. and Nanda, A. (2014) A Comparison of Lumboperitoneal and Ventriculoperitoneal Shunting for Idiopathic Intracranial Hypertension: An Analysis of Economic Impact and Complications Using the Nationwide Inpatient Sample. Neurosurgical Focus, 37, E4.
[20] Peleggi, A.F. and Lovely, T.J. (2012) Treatment of Delayed Chiari Malformation and Syringomyelia after Lumboperitoneal Shunt Placement: Case Report and Treatment Recommendations. Surgical Neurology International, 3, 101.
https://doi.org/10.4103/2152-7806.100369

  
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