Role of Lumbopleural Shunt in Management of Idiopathic Intracranial Hypertension

Abstract

Idiopathic intracranial hypertension (IIH) denotes the condition of increased intracranial pressure without a clear underlying pathologic condition of the brain. The treatment plan should be conducted to save vision. Treatment options include medications, serial lumbar punctures, and surgical intervention. Surgery is indicated once visual loss continues despite optimum medical therapy. This is a prospective study carried out during a period of 2 years. Cases were those who fulfilled the modified Dandy criteria for the diagnosis of IIH. All cases experienced a previously failed lumboperitoneal shunt. This study was approved by The Ethical Committee of Mansoura Faculty of Medicine. The following data were gathered for analysis: age, sex, presenting symptoms, number of shunt failures, apparent causes of failure, cerebrospinal fluid opening pressure on lumbar puncture, visual acuity before surgery, operative time, visual acuity at 3 and 6 months and 1 year, and any procedure-related or device-related complication. Our study included 12 patients with lumboperitoneal shunt failure, all of which were women with mean age of 33 years. The major presenting symptom was headache. The main cause of failure was shunt migration (n= 10, 83.3%). Mean cerebrospinal fluid opening pressures was 37 cmH2O. The mean operative time was 42.5 minutes. The lumbopleural shunt is a potentially effective technique in terms of symptoms control and vision improvement in treatment of IIH. The technique is safe, less time-consuming, and more suitable for morbid obese patients with high body fat percentages.