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

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.

STEREOTACTIC VENTRICULOPERITONEAL SHUNTING FOR REFRACTORY IDIOPATHIC INTRACRANIAL HYPERTENSION

Neurosurgery ◽

10.1227/01.neu.0000255456.12978.31 ◽

2007 ◽

Vol 60 (6) ◽

pp. 1039-1044 ◽

Cited By ~ 38

Author(s):

Basel Abu-Serieh ◽

Keyvan Ghassempour ◽

Thierry Duprez ◽

Christian Raftopoulos

Keyword(s):

Long Term Results ◽

Ventricular Catheter ◽

Term Outcome ◽

Long Term Outcome ◽

Visual Deficits ◽

Ventriculoperitoneal Shunting

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.

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):

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.

Long-term results of cystoperitoneal shunt placement for the treatment of arachnoid cysts in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.7.peds11540 ◽

2012 ◽

Vol 10 (4) ◽

pp. 302-305 ◽

Cited By ~ 18

Author(s):

Bin Zhang ◽

Yuqi Zhang ◽

Zhenyu Ma

Keyword(s):

Arachnoid Cysts ◽

Long Term Results ◽

Shunt Revision ◽

Single Institution ◽

Group 13 ◽

Shunt Placement ◽

Shunt Treatment ◽

Shunt Dependency

Object The authors present a single-institution experience in shunt treatment for arachnoid cysts (ACs). Methods Between January 2003 and January 2005, 62 patients with ACs underwent cystoperitoneal (CP) shunt placement at the authors' institution. All patients were evaluated with CT or MRI studies and had regular follow-up examinations. Results Forty-six cysts (74%) were within the sylvian fissure, 8 (13%) were in the cerebral convexity, and 8 (13%) were infratentorial. A CP shunt was placed in all patients. Follow-up imaging studies showed that 59 (95%) of 62 ACs reduced in size during a mean postoperative follow-up period of 6.5 years (range 6–8 years). Although a CP shunt was effective in achieving early obliteration, shunt dependency occurred within the patient group (13%). Shunt revision for various reasons was performed in 16 patients (26%). Conclusions Shunt placement is a safe and effective surgical treatment for symptomatic ACs in children, although efforts should be made to decrease complications in the procedure.

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

Neurology ◽

10.1212/01.wnl.0000299893.43918.a8 ◽

2008 ◽

Vol 70 (8) ◽

pp. 634-640 ◽

Cited By ~ 68

Author(s):

V. A. Shah ◽

R. H. Kardon ◽

A. G. Lee ◽

J. J. Corbett ◽

M. Wall

Keyword(s):

Long Term Follow Up

Persistent shunt dependency and very late shunt failure in a 3-year-old boy with idiopathic intracranial hypertension (IIH)

Child s Nervous System ◽

10.1007/s00381-016-3316-7 ◽

2016 ◽

Vol 33 (2) ◽

pp. 213-215 ◽

Cited By ~ 1

Author(s):

Anne Henriette Paulsen ◽

Bernt Johan Due-Tønnessen ◽

Tryggve Lundar ◽

Karl-Fredrik Lindegaard

Keyword(s):

Shunt Failure ◽

Shunt Dependency

Idiopathic intracranial hypertension is not benign; a prospective long-term follow-up study

The Journal of Headache and Pain ◽

10.1186/1129-2377-14-s1-p167 ◽

2013 ◽

Vol 14 (S1) ◽

Author(s):

H Yri ◽

M Wegener ◽

B Sander ◽

R Jensen

Keyword(s):

Follow Up Study ◽

Long Term Follow Up

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 ◽

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.