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

摘要

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.