Introduction: Idiopathic intracranial hypertension (IIH) is a condition characterized by elevated intracranial pressure due to an unknown etiology. It primarily affects overweight, reproductive-age women. Lumboperitoneal (LP) shunts, ventriculoperitoneal (VP) shunts, and optic nerve sheath fenestration (ONSF) are the most acceptable surgical techniques used in the management of IIH. While demonstrated to be effective in controlling symptoms of IIH, older LP shunt systems have been criticized for potential development of low pressure symptoms.
Methods: We report our experience with LP shunts with the programmable STRATA valve and small lumen peritoneal catheters. Our series included seven patients with IIH (all female) who underwent insertion of an LP shunt with a programmable valve.
Results: Mean opening pressure was 34.8 cm H2O. Valve pressure settings ranged from 3cm H2O to 17 cm H2O with one patient requiring post-operative adjustment due to low pressure symptoms. Pre-operative and post-operative visual fields, visual acuity, and disc status were recorded. 100% of patients who underwent the procedure showed improvement in objective visual testing at follow-up in addition to improvement in headache.
Conclusions: Programmable LP shunts are superior to non-programmable valves due to the ability to avoid symptoms of over-drainage. They are also superior to VP Shunts due to lower infection rates and avoidance of intra-cerebral complications with the advantage of regulating CSF flow. In conclusion, the programmable valve is effective in controlling signs and symptoms of IIH, and should be considered as first-line management over traditional LP systems and VP shunts. A prospective randomized multi centre clinical trial should be conducted to compare the efficacy of these surgical techniques.
Patient Care: By allowing clinicians to recognize advantages of programmable LP shunts versus traditional LP valves and other CSF diversion techniques such as VP Shunts.
Learning Objectives: By the conclusion of the session participants should be able to:
1) Discuss the basic pathophysiology of IIH
2) Understand the modified Dandy criteria for IIH
3) Identify effective treatments for symptomatic IIH
4) Discuss the advantages of programmable LP valves vs standard LP Shunts