Introduction: Idiopathic intracranial hypertension (IIH) most often afflicts obese women of childbearing age. Common signs and symptoms include headache, papilledema, and vision loss. While medical management is first line therapy, many patients require surgical intervention. The most common surgical intervention is cerebrospinal fluid diversion via a ventriculoperitoneal (VP) or lumboperitoneal shunt. We present our experience treating IIH using VP shunts over a four year period.
Methods: A retrospective chart review was performed on patients who underwent VP shunt placement for IIH by the senior author.
Results: 21 patients underwent VP shunt placement with a mean follow up of 20 months. Headaches improved in 86% of patients treated, with an average improvement of 4.5 points on a visual analog pain scale. Improvement of papilledema was seen in 80% of the patients. Visual acuity deficits improved in 71% of the patients (71%) and visual field deficits in 44% of the patients. 3 patients experienced a complication from VP shunt placement requiring removal of the hardware. Of the remaining18 patients, 44% (8 patients) required at least one shunt revision due to failure. 2 of these 8 patients would require further revisions. Total of 13 revisions were performed. Of the 8 patient requiring revisions, 4 experienced a surgical complication.
Conclusions: Placement of a VP shunt is an efficacious method for relieving the symptoms of IIH in patients that fail medical therapy. However, the durability of benefits may be limited and further surgical revisions can be anticipated in over half the patients. Revisions are also associated with an increased rate of surgical complications. As the incidence of IIH is likely to increase in the future due to the increasing obesity rate, VP shunting needs to be compared to other treatment options.
Patient Care: Our research will improve patient care by giving both the physician and by extension, the patient, a better understanding of the efficacy and limitations to VP shunting for IIH
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Develop a basic understanding of treatment options for IIH
2) Understand the efficacy of VP shunting for treating symptoms of IIH
3) Understand the risks associated with VP shunting for IIH
4) Describe the issues with longevity of benefit with VP shunting for IIH