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Complications of Lumboperitoneal Shunts for Idiopathic Intracranial Hypertension

Authors:
Ignacio Jusue-Torres at Mayo Clinic Health System
Ignacio Jusue-Torres
Jamie B Hoffberger
Jamie B Hoffberger
Jamie B Hoffberger
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Daniele Rigamonti at Johns Hopkins Medicine
Daniele Rigamonti
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Abstract

Introduction: For the past half century, the mainstay of cerebrospinal fluid (CSF) shunting for Idiopathic Intracranial Hypertension (IIH) has been lumboperitoneal (LP) shunt surgery. LP shunt has been associated with higher failure rates compared to ventriculoperitoneal shunts. However, there is no uniformity in the reporting of complication and surgical revision rates. The goals of this study were to understand better the complications and surgical revisions rates associated with LP shunt insertion in IIH patients with the objective of providing better information about the different therapeutical option’s outcomes when counseling for a better informed consent. Material & Methods: Twenty-six patients with IHH undergoing lumboperitoneal shunt surgery for the first time by the senior author at an academy tertiary-care institution were retrospectively reviewed. Presence of complications and surgical revisions were the two main outcomes variables. Logistic regression analysis was used first to assess if there was a correlation between preoperative patient characteristics and complications and second to evaluate if there was any association between preoperative patient characteristics or postsurgical complications and surgical revision. Results: Primary shunts were, inserted into 26 patients and 58% required revision surgery. Median time to surgical revision was 4 (3-22) months. Multivariate logistic analysis showed no statistical significant association between preoperative patient characteristics and postoperative complications as well as no relationship between either preoperative characteristics or complications and surgical revisions. Conclusion: Our data suggests that our revisions were mostly performed to reduce the rate of post-LP shunt tonsilar herniation. The introduction of newer hardware is expected to positively impact the symptoms and signs of overdrainage post-LP shunt and the need of revision.
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 
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 
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 
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... The range of the body mass index (BMI) was 23.9-44.6 with an average of 33.3. Data collected by Jusué-Torres et al. [25] was BMI average of 36 (range 30-41). We found that the incidence of the IIH is increasing with weight (73% of cases presented with BMI value of greater than 30). ...
... [23] El-Saadany et al. [28] , using also valveless shunt in 22 cases for 3 years, found infection in 9%, overdrainage 13.6% & shunt obstruction 27% (most of them due to migration of distal catheter). [29] Jusué-Torres et al. [25] , using horizontal-vertical (H-V) lumbar valve in 26 patients for 20 years, found that 69% of the cases developed at least one complication (infection 8%, CSF leak 15%, overdrainage 35%, shunt obstruction 19%). Shunt revision was needed for 58% of cases (mostly due to overdrainage and tonsillar herniation), Wang et al. [30] compared 46 patients treated with Integra H-V valve versus 21 patients treated with conventional valveless Silastic LP shunt, found that overdrainage was 8.6% in the first versus 33% in the latter. ...
Evaluation of the Effectiveness of Adjustable [Programmable] L-P Shunt Compared to the Conventional {Non Programmable} L-P Shunts Regarding Post- Operative Outcome and Complications in IIH
Article
Full-text available
  • Nov 2024
Background: Surgical treatment of idiopathic intracranial hypertension (IIH) includes the use of L.P {lumboperitoneal} shunt have two type from L.P shunt. conventional one {non programmable} and second type adjustable (programmable) was introduced in the last decades. Aim of the Study: To evaluate the effectiveness of adjustable L-P shunt compared to the conventional {non programmable} L-P shunts regarding post-operative outcome and complications. Patients and Methods: This is cohort study [ retrospective and prospective] single-center study of 58 patients with idiopathic intracranial hypertension treated in the neurosurgical department at the Martyr Ghazi Al-Hariri Hospital for Specialized Surgery for a period extending from August 16 th , 2015 till November 26 st , 2019. Patients had been referred to the neurosurgical unite from Baghdad city neuromedicine unit or from other centers. Results: This study has two-parts prospective used programmable L.P shunt for 33 patients), Second part retrospective used an old L.P shunt {non programmable} for 25 patients. 88% of the patients were female, with a mean age of 34 years and a high prevalence of obesity. All patients presented with headaches, papilledema, and visual disturbances, and underwent adjustable LP shunt placement, resulting in clinical improvement in 97% of cases for headaches and 85% for visual symptoms. Postoperative complications were minimal, with over-shunting and under-shunting being the most common issues. Conclusions: In conclusion, comparing the adjustable (programmable) LP shunt and conventional (non-programmable) when used to treat IIH has the P value non-significant regarding the infection, over drainage, revision and the CSF leak.
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... She got blind, unfortunately, and was lost to follow up. Comparable to Jusue et al [20] study which assessed the outcome, complications and surgical revision rates associated with LP shunt insertion in IIH patients, 26 patients with IHH who underwent lumboperitoneal shunt surgery for the first time by the senior author at an academy tertiary-care institution were retrospectively reviewed. Primary shunts were inserted into the 26 patients and 58% of them required revision surgery. ...
... Primary shunts were inserted into the 26 patients and 58% of them required revision surgery. Median time to surgical revision was 4 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) months. This result was significantly higher than the present result. ...
Lumboperitoneal Shunt with No Valve or Antisiphon Device in Management of Idiopathic Intracranial Hypertension at The National Center of Neurological Sciences Among Sudanese Patients
Article
Full-text available
  • Nov 2022
Background: Surgical treatment of idiopathic intracranial hypertension includes cerebrospinal fluid diversion procedures most commonly lumboperitoneal shunt. Lumboperitoneal shunt addresses the cause of both headache and papilledema more directly by effecting a global reduction of intracranial pressure.
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... The primary method of treating PTC by draining CSF is shunt surgery, which can be performed using a LP shunt or a VP shunt. However, LP shunts are associated with higher failure rates compared to VP shunts [6]. Nevertheless, there is a lack of consistency in the reporting of significant complications with each technique [7]. ...
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... La implantación de la DLP es completamente extracraneal 4 , lo que minimiza los riesgos asociados a la colocación de DVP 22 . Por otra parte, el uso de válvulas programables disminuye significativamente las complicaciones derivadas por el hiperdrenaje 4 . ...
La derivación lumbo-peritoneal en la edad pediátrica y el papel de la imagen en su valoración
Article
  • Feb 2022
  • Radiologí
Resumen La derivación lumbo-peritoneal permite regular el flujo de líquido cefalorraquídeo estableciendo una conexión entre el saco tecal y la cavidad peritoneal. Entre las indicaciones en la población pediátrica se encuentra principalmente la hipertensión intracraneal idiopática, siendo también útil en el tratamiento de la hidrocefalia postinfecciosa, posthemorrágica y normotensiva, en el seudomeningocele posquirúrgico o ante una fuga de líquido cefalorraquídeo. En este artículo, mediante la revisión de 9 casos de nuestro centro, se pretende mostrar la normalidad del dispositivo en las pruebas de imagen y realizar una breve revisión de las posibles complicaciones asociadas, neurológicas y abdominales.
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... Increased CSF secretion including shunt surgery. These non-bariatric approaches are limited by a high failure which includes symptom recurrence in 48% by 36 months [40] and typical revision rates of at least 30-60% [41][42][43]. Bariatric surgery has the advantage of directly targeting obesity and its associated metabolic dysfunction as well as mitigating other obesity-related co-morbidities. Further work is however necessary to clarify whether bariatric surgery offers an equivalence in the rapidity of treatment outcome in the context of acute or rapidly progressive visual loss, given the time required for both multidisciplinary preoperative workup and resolution of symptoms [12]. ...
Bariatric Surgery or Non-surgical Weight Loss for Idiopathic Intracranial Hypertension? A Systematic Review and Comparison of Meta-analyses
Article
Full-text available
  • Feb 2017
  • OBES SURG
Background Idiopathic intracranial hypertension (IIH) is associated with obesity and weight loss by any means is considered beneficial in this condition. Objectives This study aims to appraise bariatric surgery vs. non-surgical weight-loss (medical, behavioural and lifestyle) interventions in IIH management. MethodsA systematic review and meta-analyses of surgical and non-surgical studies. ResultsBariatric surgery achieved 100% papilloedema resolution and a reduction in headache symptoms in 90.2%. Non-surgical methods offered improvement in papilloedema in 66.7%, visual field defects in 75.4% and headache symptoms in 23.2%. Surgical BMI decrease was 17.5 vs. 4.2 for non-surgical methods. Conclusions Whilst both bariatric surgery and non-surgical weight loss offer significant beneficial effects on IIH symptomatology, future studies should address the lack of prospective and randomised trials to establish the optimal role for these interventions.
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Lumboperitoneal shunting in pediatric patients and the role of imaging in its evaluation
Article
  • Mar 2022
Lumboperitoneal shunting makes it possible to regulate the flow of cerebrospinal fluid by establishing a connection between the thecal sac and the peritoneal cavity. The main indication for lumboperitoneal shunting in children is idiopathic intracranial hypertension, but the technique is also useful in the treatment of postinfectious, posthemorrhagic, and normotensive hydrocephalus, as well as in the treatment of postsurgical pseudomeningocele or leakage of cerebrospinal fluid. This article reviews nine cases treated at our centre to show the normal imaging findings for lumboperitoneal shunts in children and to provide a succinct review of the possible neurological and abdominal complications associated with this treatment.
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Diagnostic Assessment of Adult Hydrocephalus Log compared to standard normal pressure hydrocephalus diagnostic tools
Conference Paper
Full-text available
  • Sep 2015
Median age at presentation was 76 (71-80) years old. TUG (p 0.05). LP log improvement was associated with surgical indication OR: 24.5 95%CI (2.4248.12) (p=0.007). Conclusions LP log showed a higher sensitivity and diagnostic accuracy detecting clinical differences in NPH than the current diagnostic approach. Our next step is to conduct a cross-validation analysis of the diagnostic and prognostic accuracy of this new tool.
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Lumboperitoneal shunts: Review of 409 cases
Article
Full-text available
  • Jul 2004
A prospective study was carried out to evaluate the lumboperitoneal shunt procedure. Four hundred and nine patients having communicating hydrocephalus were selected for the procedure during a 10-year period from March 1992 to February 2002. The average follow-up was 45.34 months. Tubercular meningitis (TBM)-related hydrocephalus was detected in 285 patients. Forty per cent of the patients were less than 15 years of age. Glasgow Coma Scale (GCS) of less than 8 was seen in 40% patients and 14.9% patients were in GCS 13-15. At the time of discharge 56.7% patients improved in their GCS to 13 -15 and 14.9% were in GCS 8 or less. The overall mortality was 5.13% and shunt-related mortality was seen in 2% patients. Shunt malfunction requiring revision was seen in 32 patients (7.8%) and the total number of shunt revisions was 44 (11%). Shunt infection was noted in 3.4% patients. CSF leak at the lumbar end occurred in 12 patients. Four patients required conversion of LP shunt to VP shunt. Lumboperitoneal shunt is an effective shunting procedure in communicating hydrocephalus.
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