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CSF diversion in refractory idiopathic intracranial hypertension: single-centre experience and review of efficacy

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Abstract

Purpose

The current surgical management strategies for refractory cases of idiopathic intracranial hypertension (IIH) remain unresolved. We evaluated the outcome of our paediatric patients who were offered a CSF diversion procedure in order to control their symptoms.

Methods

We retrospectively reviewed the medical notes of the patients under 16 years of age, who presented in our centre from 2005 to 2010, with a confirmed diagnosis of IIH, and ultimately had a lumboperitoneal shunt (LPS). We describe their immediate postoperative course, shunt-related complications and recent outcome.

Results

Seven patients presented at a mean age of 8.7 years. Two presented with significant visual loss and had a shunt acutely; the remaining five presented with headaches and were shunted within 2 years. In the immediate postoperative period two patients experienced low-pressure symptoms. All patients required shunt revisions; in total 15 revisions took place, mainly secondary to symptomatic overdrainage or obstruction. After a mean follow-up of 26 months, two patients have diminished visual acuity at least on one side; only one patient became headache-free, despite resolution of the CSF pressure post diversion in four out of the six remaining patients.

Conclusions

All patients required shunt revisions and 6/7 (85.7 %) had persisting headaches at their last follow-up. It is apparent that once functional, the LPS seems adequate to lower the CSF pressure but not effective in eliminating symptoms.

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References

  1. Friedman DI, Jacobson DM (2002) Diagnostic criteria for idiopathic intracranial hypertension. Neurology 59(10):1492–1495

    Article  PubMed  Google Scholar 

  2. Lueck CJ, McIlwaine GG (2005) Interventions for Idiopathic Intracranial Hypertension. Cochrane Database Syst Rev 20 (3):CD003434

  3. Ragwala LM, Liu GT (2007) Pediatric idiopathic intracranial hypertension. Surv Ophthalmol 52(6):597–617

    Article  Google Scholar 

  4. Avery RA, Shah SS, Licht DJ, Seiden JA (2010) Reference range for cerebrospinal fluid opening pressure in children. N Engl J Med 363(9):891–893

    Article  PubMed  CAS  Google Scholar 

  5. Higgins JNP, Cousins C, Owler BK, Sarkies N, Pickard JD (2003) Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry 74:1662–1666

    Article  PubMed  CAS  Google Scholar 

  6. Brazis PW (2008) Clinical review: the surgical treatment of idiopathic pseudotumor cerebri (idiopathic intracranial hypertension). Cephalalgia 28:1361–1373

    Article  PubMed  CAS  Google Scholar 

  7. McGirt MJ, Woodworth G, Thomas G, Miller N, Williams M, Rigamonti D (2004) Cerebrospinal fluid shunt placement for pseudotumor cerebri-associated intracrable headache: predictors of treatment response and an analysis of long term outcomes. J Neurosurg 101:627–632

    Article  PubMed  Google Scholar 

  8. Abubaker K, Ali Z, Raza K, Bolger C, Rawluk D, O'Brien D (2011) Idiopathic intracranial hypertension: lumboperitoneal shunts versus ventriculoperitoneal shunts—case series and literature review. Br J Neurosurg 25(1):94–99

    Article  PubMed  Google Scholar 

  9. Eggenberg ER, Miller NR, Vitale S (1996) Lumboperitoneal shunt for the treatment of pseudotumor cerebri. Neurology 46:1524–1530

    Article  Google Scholar 

  10. Nadkarni TD, Rekate HL, Wallace D (2008) Concurrent use of a lumboperitoneal shunt with programmable valve and ventricular access device in the treatment of pseudotumor cerebri: review of 40 cases. J Neurosurg Pediatrics 2:19–24

    Article  Google Scholar 

  11. Standridge SM (2010) Idiopathic intracranial hypertension in children: a review and algorithm. Pediatr Neurol 43:377–390

    Article  PubMed  Google Scholar 

  12. Thambisetty M, Lavin PJ, Newman NJ, Biousse V (2007) Fulminant idiopathic intracranial hypertension. Neurology 68:229–232

    Article  PubMed  Google Scholar 

  13. Ahmed RM, Wilkinson M, Parker GD, Thurtell MJ, Macdonald J, McCluskey PJ, Allan R, Dunne V, Hanlon M, Owler BK, Halmagyi GM (2011) Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictors. AJNR 32:1408–1414

    Article  PubMed  CAS  Google Scholar 

  14. Arac A, Lee M, Steinberg GK, Marcellus M, Marks MP (2009) Efficacy of endovascular stenting in dural venous sinus stenosis for the treatment of idiopathic intracranial hypertension. Neurosurg Focus 27(5):E14

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Paediatric Neurosciences, Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners Academic Health Science Centre, Westminster Bridge Road, London, SE1 7EH, UK

    Georgios Niotakis, Dionysios Grigoratos & Ming Lim

  2. Paediatric Neurosurgery, King’s College Hospital, King’s Health Partners Academic Health Science Centre, Denmark Hill, London, SE5 9RS, UK

    Chris Chandler

  3. Paediatric Ophthalmology, Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners Academic Health Science Centre, Westminster Bridge Road, London, SE1 7EH, UK

    Danny Morrison

Authors
  1. Georgios Niotakis
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  2. Dionysios Grigoratos
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  3. Chris Chandler
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  4. Danny Morrison
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  5. Ming Lim
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Corresponding author

Correspondence to Ming Lim.

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Niotakis, G., Grigoratos, D., Chandler, C. et al. CSF diversion in refractory idiopathic intracranial hypertension: single-centre experience and review of efficacy. Childs Nerv Syst 29, 263–267 (2013). https://doi.org/10.1007/s00381-012-1895-5

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  • DOI: https://doi.org/10.1007/s00381-012-1895-5

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