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Vol. 32. Issue 2.
Pages 53-61 (March - April 2021)
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Vol. 32. Issue 2.
Pages 53-61 (March - April 2021)
Clinical Research
DOI: 10.1016/j.neucie.2020.03.002
Lumbo-peritoneal shunt as treatment modality for visual symptoms in idiopathic intracranial hypertension: A single institution experience
Derivación lumboperitoneal como modalidad terapéutica para los síntomas visuales de la hipertensión intracraneal idiopática: experiencia de una única institución
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Shyam Sundar Krishnana,1,
Corresponding author
shyamsundarkrishnan76@gmail.com

Corresponding author.
, Pulak Nigamb,1, Adarsh Manuelc,1, Madabushi Chakravarthy Vasudevanc,1
a Kauvery Hospital, 199 Luz Church Road, Mylapore, Chennai, Tamil Nadu, India
b Medanta Multi-Speciality Hospital, 8, PU4, Scheme – 54, Indore, Madhya Pradesh, India
c Post Graduate Institute of Neurological Surgery, Dr. Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services Multi-speciality Hospital & Research Centre, TTTI Post, Taramani, Chennai 600113, Tamil Nadu, India
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Table 1. Modified diagnostic criteria for IIH. Diagnostic Criteria for IIH.
Table 2. Summary of patient data.
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Abstract
Objectives

To evaluate the efficacy of lumbo-peritoneal shunt (LPS) in patients of idiopathic intracranial hypertension presenting with visual symptoms.

Methods

Between Apr. 2014 and Mar. 2018, 70 patients of Idiopathic Intracranial Hypertension (IIH) underwent treatment at our institution. Patients were evaluated for neurological and ophthalmological status and were subjected to LPS depending on their symptoms.

Results

Mean opening pressure was 29.97±5.33cm of water and mean Body-Mass Index (BMI) was 26.51±3 and the two were significantly correlated (p-value 0.006). All patients with visual symptoms (23) underwent LPS and others (47) were managed medically. All patients with LPS and 25 of medically managed patients improved, while 22 medically-managed patients required LPS due to deterioration in visual symptomatology. The proportion of patients showing complete resolution of features of IIH was significantly different between the three groups. Of the 7 patients with shunt extrusion/migration, only 2 required revision.

Conclusion

LPS is an equally effective and more technically familiar modality for treatment of IIH for neurosurgeons and should be offered to asymptomatic patients with objective visual signs. Shunt extrusion/migration may not always warrant revision due to “mini-shunt” that drains Cerebro-Spinal Fluid (CSF) through shunt tract even after extrusion.

Keywords:
Idiopathic intracranial hypertension
Benign ICT
Pseudotumour cerebri
Lunmbo-peritoneal shunt
Visual symptoms
Resumen
Objetivos

Evaluar la eficacia de la derivación lumboperitoneal (DLP) en pacientes con hipertensión intracraneal idiopática con síntomas visuales.

Métodos

Entre abril de 2014 y marzo de 2018, 70 pacientes con hipertensión intracraneal idiopática (HII) se sometieron a tratamiento en nuestra institución. Los pacientes se evaluaron para determinar el estado neurológico y oftalmológico y se sometieron a DLP en función de sus síntomas.

Resultados

La presión de apertura media fue de 29,97±5,33cm de agua y el índice de masa corporal (IMC) medio fue de 26,51±3, y los 2 presentaron una correlación significativa (valor de p=0,006). Todos los pacientes con síntomas visuales (23) se sometieron a DLP y otros (47) recibieron tratamiento farmacológico. Todos los pacientes con DLP y 23 de los pacientes que recibieron tratamiento farmacológico mejoraron, mientras que 22 pacientes con tratamiento farmacológico precisaron DLP debido al deterioro en la sintomatología visual. La proporción de los pacientes que mostró resolución completa de las características de la HII fue significativamente diferente entre los 3 grupos. De los 7 pacientes con extrusión/migración de la derivación, solo 2 precisaron revisión.

Conclusión

La DLP es una modalidad igual de eficaz y más familiar desde un punto de vista técnico para los neurocirujanos para el tratamiento de la HII y debe ofrecerse a los pacientes asintomáticos con signos visuales objetivos. La extrusión/migración de la derivación puede no justificar siempre una revisión debido a la «miniderivación» que drena el líquido cefalorraquídeo (LCR) a través del conducto de derivación incluso después de la extrusión.

Palabras clave:
Hipertensión intracraneal idiopática
Hipertensión intracraneal benigna
Seudotumor cerebral
Derivación lumboperitoneal
Síntomas visuales

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