Lumbopleural Shunting as an Alternative Cerebrospinal Fluid Diversion Modality for Management of Idiopathic Intracranial Hypertension: Is It Time for a Change?

Abstract

diopathic intracranial hypertension (IIH), as its name implies, is a disorder characterized by elevated cerebrospinal fluid I (CSF) pressure of an unknown etiology. First reported by Quincke in 1893 as “meningitis serosa,” this clinical syndrome has historically been a matter of serious contention, with its nomenclature subject to substantial changes over time. In 1904, Nonne introduced the term “pseudotumor cerebri.” The syndrome was subsequently renamed “benign intracranial hypertension” by Foley in 1955. With a high proportion of patients demonstrating permanent visual impairment, the term “benign” was deemed inappropriate, and the term “idiopathic” was unanimously adopted. Often considered as a diagnosis of exclusion, IIH predominantly affects obese women of reproductive age and is best defined by myriad symptoms, most commonly headaches, transient obscuration of vision, pulsatile tinnitus, photopsia, backache, retrobulbar pain, diplopia, and severe visual impairment. Analogous to its nomenclature, diagnostic criteria for IIH have evolved considerably to integrate our enhanced understanding of the disease with developments in technology. The original diagnostic classification by Dandy in 1937 included signs of increased intracranial pressure (>25 cm H2O) with normal CSF composition, absence of any localizing signs except abducens nerve palsy, and normal or slit ventricles with no intracranial mass lesion as evident on ventriculography. This classification was initially modified by Smith in 1985 to accommodate the advent of computed tomography, used in diagnosis of IIH primarily to exclude secondary causes predisposing to intracranial hypertension, including space-occupying lesions that were likely unnoticed in the previous era. The modification of the diagnostic