Long-term follow-up of idiopathic intracranial hypertension: The Iowa experience

Abstract OBJECTIVE Recent reports have shown promising short- to medium-term results in patients with refractory idiopathic intracranial hypertension (IIH) treated using the stereotactic ventriculoperitoneal shunting (SVPS) technique. However, the long-term clinical efficacy of this technique remains questionable. This report provides the long-term results of SVPS in treating refractory IIH patients. METHODS We reviewed the medical charts of nine consecutive patients (mean age, 26.4 yr; range, 4–63 yr) treated using either a frame-based or frameless SVPS technique for IIH. RESULTS The mean postoperative follow-up period was 44.3 months (range, 6–110 mo). Before shunting procedures were performed, each patient presented with intractable headache, and five patients (55.6%) had mild to moderate visual deficits. The last follow-up assessment showed that after shunting was performed, eight patients (89%) were headache-free. Only one patient had recurrent headache; however, this patient's pain was much less frequent and severe than before the shunting procedure was completed and was concomitant with recent weight increase. Visual deficits were resolved in three patients and remained stable in two who already had optic nerve atrophy before shunting was completed. Twelve SVPS procedures were performed on our patients. Nine shunt revisions were needed in six patients because of infection (n = 5, including two revisions in one patient), valve dysfunction (n = 2), distal obstruction (n = 1), and ventricular catheter malpositioning (n = 1). No patient had proximal catheter obstruction. CONCLUSION Given the favorable long-term outcome of the SVPS technique for refractory IIH, we are encouraged to apply this procedure on our patients. More invasive approaches should be reserved for patients who have SVPS failure.

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Venous Sinus Stent-Assisted Angioplasty for Refractory Benign Intracranial Hypertension

Interventional Neuroradiology ◽

10.1177/159101990300900114 ◽

2003 ◽

Vol 9 (1) ◽

pp. 79-82 ◽

Cited By ~ 1

Author(s):

M. Zhongrong ◽

L. Feng ◽

L. Shengmao ◽

Z. Fengshui

Keyword(s):

Intracranial Hypertension ◽

Clinical Improvement ◽

Venous Sinus ◽

Dural Sinus ◽

Benign Intracranial Hypertension ◽

Long Term Follow Up ◽

Sinus Stenosis ◽

Good Patency

Two patients with dural sinus stenosis of different causes presenting with refractory benign intracranial hypertension were confirmed by angiogram. Stent-assistant angioplasty was used to dilate the stenosed sinusesand led to prompt clinical improvement. Relative long-term follow-up showed good patency of the stented sinuses.

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Venous sinus stenting for idiopathic intracranial hypertension is not associated with cortical venous occlusion

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011692 ◽

2015 ◽

Vol 8 (6) ◽

pp. 594-595 ◽

Cited By ~ 15

Author(s):

Michael R Levitt ◽

Felipe C Albuquerque ◽

Andrew F Ducruet ◽

M Yashar S Kalani ◽

Celene B Mulholland ◽

...

Keyword(s):

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Venous Occlusion ◽

Venous Sinus ◽

Radiological Data ◽

Angiographic Data ◽

Intracranial Complications ◽

Dural Venous Sinus

BackgroundThe effect of dural venous sinus stenting has been investigated for the treatment of idiopathic intracranial hypertension (IIH) but the effect of stenting on the long-term patency of the cortical draining veins, especially the vein of Labbé (VOL), remains unknown.MethodsWe reviewed our database of 38 patients with IIH with 41 stented dural venous sinuses between October 2006 and December 2014. Demographic, clinical, and radiological data were reviewed. Follow-up catheter angiographic data were included when available.ResultsStent placement spanned the ostium of the VOL in 35 patients (92.1%), with no immediate effect on the drainage of the VOL. Follow-up angiography (mean 35.1 months, range 1.7–80.7 months) was available in 24 patients, 21 of whom had stents spanning the VOL ostium. The VOL remained patent without occlusion or drainage alteration in all 21 patients. There were no immediate or long-term intracranial complications.ConclusionsDural venous sinus stenting for patients with IIH does not affect the immediate or long-term patency of the VOL and is not associated with intracranial complications.

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Will CSF Diversion in Patients with Idiopathic Intracranial Hypertension (IIH) Lead to Long-Lasting Shunt Dependency?

10.5772/intechopen.96291 ◽

2021 ◽

Author(s):

Tryggve Lundar ◽

Bernt Johan Due-Tønnessen

Keyword(s):

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Shunt Failure ◽

Shunt Treatment ◽

Long Time ◽

Shunt Dependency ◽

Csf Diversion

Long-term shunt dependency rates in patients treated for IIH with CSF diversion have not been established. We therefore present our experience with 5 children shunted for IIH during the years 1984–2000 with very long-time follow-up. Three out of these patients have experienced late or very late episodes of severe shunt failure during the second or third decade after initial shunt treatment. They were all boys and may not be representative for IIH patients as a whole. Three of them appear, however, to be permanently shunt dependent, indicating that long-term shunt-dependency in children treated for IIH with CSF diversion may be more common than previously expected.

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Craniofaciosynostosis

Oxford Textbook of Neurological Surgery ◽

10.1093/med/9780198746706.003.0086 ◽

2019 ◽

pp. 993-998

Author(s):

Federico Di Rocco ◽

Pierre-Aurelien Beuriat ◽

Eric Arnaud

Keyword(s):

Intracranial Hypertension ◽

Facial Morphology ◽

Surgical Indications ◽

Cosmetic Techniques ◽

Skull Shape ◽

Eye Protection ◽

Cranial Growth ◽

Long Term Follow Up

Craniosynostosis is a condition in which there is a premature fusion of one or more sutures of the skull with a modification of cranial growth and an abnormal skull shape. The shape is specific to the suture involved so the diagnosis is essentially clinical. The genetic causes remain largely unknown. Molecular researches have identified several mutations. Complications can result to the deformation of the skull but also abnormal facial morphology. Cerebellar tonsillar prolapse, hydrocephalus, intracranial hypertension, insufficient eye protection, respiratory obstructions, and orthodontic problems are the most common. Several factors play a role in the surgical indications. The aim of the surgery is functional and cosmetic. Techniques have evolved from simple strip to total calvarial and supraorbital remodelling, osteogenic bone distraction, and endoscopic procedures. In all craniosynostosis, long-term follow-up is mandatory because there is a risk of secondary synostosis which exists independently from the originally affected suture.

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Quality of life, need for retreatment, and the re-equilibration phenomenon after venous sinus stenting for idiopathic intracranial hypertension

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016124 ◽

2020 ◽

Vol 13 (1) ◽

pp. 79-85 ◽

Cited By ~ 1

Author(s):

Rebecca M Garner ◽

Jennifer Bernhardt Aldridge ◽

Stacey Q Wolfe ◽

Kyle M Fargen

Keyword(s):

Quality Of Life ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Surgical Intervention ◽

Venous Sinus ◽

Sinus Stenosis ◽

Cerebrospinal Fluid Shunting

BackgroundLong term failure rates after venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) are poorly understood.MethodsRetrospective analysis was performed on a prospectively-maintained single center database to identify patients with medically refractory IIH who underwent VSS. Patients with persistent or severe recurrent symptoms after VSS undergo lumbar puncture (LP), therefore LP serves as a marker for treatment failure.Results81 patients underwent VSS with a mean follow-up of 10 months; 44 (54.3%) patients underwent LP after VSS due to persistent or recurrent symptoms at a mean of 12 months (median 7, range 2–43). There was a mean decrease in opening pressure (OP) on LP from pre- to post-VSS of 9.1 cm H2O (median 9.5). Overall, a total of 21 (25.9%) patients underwent further surgical intervention following VSS, including five who underwent repeat VSS (6.2% of total) and 18 who underwent cerebrospinal fluid shunting (22.2% of total). There was a non-significant (p=0.18) but overall increase in quality of life scores from pre-stenting (61.2) to last follow-up (71.2), and a significant decrease in Headache Impact Test-6 (HIT-6) scores (p=0.03) with mean pre-stenting and last follow-up scores of 62.7 and 55.8, respectively.ConclusionsVSS is an effective treatment for venous sinus stenosis in IIH; however, this study found higher rates of symptomatic recurrence and need for further surgical intervention (26%) than previously reported in the literature. Recurrence of symptoms occurred at a median of 7 months, even though OP remained lower at follow-up LP, suggestive of a re-equilibration phenomenon.

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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