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Lumboperitoneal Shunt with No Valve or Antisiphon Device in Management of Idiopathic Intracranial Hypertension at The National Center of Neurological Sciences Among Sudanese Patients

November 2022

Authors:

Emad ibrahim Ahmed

Sudan University of Science and Technology

Yousif Ahmed

National centre for neuroligical sciences, khartoum, Sudan

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.

Distribution of the patients with idiopathic intracranial hypertension managed by lumboperitoneal shunt according to age group.

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Distribution of the patients with idiopathic intracranial hypertension managed by lumboperitoneal shunt according to gender.

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Distribution of the patients with idiopathic intracranial hypertension managed by lumboperitoneal shunt according to neurological deficit (Cranial Nerves were not included)

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Figures - uploaded by Emad ibrahim Ahmed

Content may be subject to copyright.

Content uploaded by Emad ibrahim Ahmed

Content may be subject to copyright.

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SVOA Neurology



SVOA Neurology

- 











 



*Corresponding Author: 

 

Received: Published: 



            

             





2017 









  



      

               

        















Keywords: 



 











237

  





               

























  



  







   

















 



 



  











   









SVOA Neurology



238













• 

• 



• 



  











-

-

-



  -





• 

• 







        

 60 







                   



 





 12 









SVOA Neurology

239

 

    

-

-





       



-



’











     





-



     

                

  -



SVOA Neurology

Figure 1. 





Figure 2. 





Figure 3. 





Figure 4. 







240



















…..

SVOA Neurology

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  



  

  

  

  



 

  



  

  

  

241



















       -   



               

-



-

       

          





SVOA Neurology





 

  



 

  



 

  



 

  



 

  



 

  

  



  

  

  



  

  

  

242



              





   











 -  

                  

-



 

--

-



                  

              



-

--



       







-

 

        

      





                  





   



  

          











  



    -





-



   -    





SVOA Neurology

243

        

       

  

    



-



-



-









                 

       

   

       

  





 



- 

 -

         





  



                   -









 -     



       

         

















• 



• 



• -

• 



SVOA Neurology

244 
 
•  
 
•  
 
•  
 
 
 
  
 
 107:1907
 
 54:538
 
 247:252258. 
 
2016; 46:15241530. 
 
12:16621666. 
 
46:198202. 
 -
-
101:627632. 
 
100:683690. 
   
  
  - 
       -
 
 ------
 -- 
 
 - 
  
- 
 
 - 
                   
--
101(4):627632. 
     -
113(6):13041308. 
 -           1
(5):357360. 
 
 
SVOA Neurology 
 

245 
 
  
 
 -’ 
35:239244. 
     
 - 
 
- 
                
- 
 
 
 ’-
-- 
  
 
 
 -
-  
SVOA Neurology 
 
“ 

”. - 
 


 

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Advances in the understanding of headache in idiopathic intracranial hypertension

Article

Full-text available

Dec 2018

Purpose of review: To review the most relevant developments in the understanding of headache in idiopathic intracranial hypertension (IIH). Recent findings: The phenotype of the typical IIH headache is diverging from the historical thinking of a raised intracranial pressure headache, with the majority being classified as having migraine. A larger proportion of those with IIH have a past medical history of migraine, compared with the general population, highlighting the importance of re-examining those who have a change or escalation in their headache. The mechanisms underlying headache in IIH are not understood. Additionally, factors which confer a poor headache prognosis are not established. It is clear, however, that headache has a detrimental effect on all aspects of the patient's quality of life and is currently ranked highly as a research priority by IIH patients to better understand the pathophysiology of headache in IIH and identification of potential headache specific therapeutic agents. Summary: Headache remains the predominate morbidity in the majority of those with IIH. Headache management is an unmet need in IIH and future studies are required to investigate the probable complex mechanisms, as well as effective management.

Complications of Lumboperitoneal Shunts for Idiopathic Intracranial Hypertension

Article

Full-text available

Jul 2014

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.

Prevalence of venous sinus stenosis in Pseudotumor cerebri (PTC) using digital subtraction angiography (DSA)

Article

Full-text available

Jun 2014

Objectives To study the prevalence of intracranial venous stenosis in Pseudotumor cerebri patients. Patients and methods Thirty patients were diagnosed having PTC according to Dandy criteria. All underwent general and neurological assessment. Radiological assessment included CT scan brain ±MRI brain without contrast, MRV. All underwent digital subtraction angiography (DSA) (venous phase) to confirm the validity of filling gaps seen at the level of MRV. Results MRV brain showed that 24 patients (80%) showed filling gaps. Digital subtraction cerebral angiography (venous phase) showed 9 patients (30%) had stenosis in their dural sinuses. MRV showed to be a good screening tool since it had 100% sensitivity and negative predictive value. However, since it has a moderate specificity (62%) with a positive predictive value (PPV) of only 35%, then lesions detected should be confirmed with digital subtraction cerebral angiography (venous phase) particularly those involving the transverse and sigmoid sinus. Conclusion Studying the intracranial venous system in patients with PTC is an important step in understanding the pathophysiology of the disease. Detection of venous sinus stenosis opens the way to a novel therapeutic option for refractory patients like venous sinus stenting.

Lumbar Peritoneal Shunt in Idiopathic Intracranial Hypertension

Article

Full-text available

Jan 2012
TURK NEUROSURG

Treatment options for idiopathic intracranial hypertension (IIH) are lumbar peritoneal shunt (LP), optic nerve fenestration, ventriculoperitoneal shunt and venous stenting. We report our experience of 24 cases of LP shunt. MATERIAL and All the patients had preoperative fundus examination, cerebrospinal fluid pressure estimation and examination, visual field charting, CT scan and MR venography. Postoperative fundus examination and visual field charting was done in all cases. Follow up ranged from 18 to 137 months. Preoperative papilledema, headache, decreased vision, optic atrophy and diplopia were seen in 24, 24, 19, 10 and 11 patients respectively. Shunt failure, CSF leak and temporary over drainage complications in the form of headache were seen in 2, 1 and 15 cases respectively. Vision improved in 10 out of 18 patients. Only one patient, out of 9 who had only perception of light and optic atrophy preoperatively, had improved vision while all patients with vision of finger counting or better without optic atrophy improved after shunt. LP shunt is safe and effective in IIH. Results in terms of improvement in vision were better in good pre operatively vision group.

Lumboperitoneal shunt for idiopathic intracranial hypertension: Patients' selection and outcome

Article

Full-text available

Sep 2011
NEUROSURG REV

Surgical treatment of idiopathic intracranial hypertension (IIH) includes cerebrospinal fluid (CSF) diversion procedures most commonly lumboperitoneal (LP) shunt. LP shunt addresses the cause of both headache and papilledema more directly by effecting a global reduction of intracranial pressure. Twenty-two cases were included in the study. All patients underwent clinical, imaging, and CSF manometry evaluations. All patients showed failure or noncompliance to medical treatment and necessitated placement of an LP shunt. Analysis of data was conducted and evaluation of outcome was assessed. Among 22 patients who underwent LP shunt placement for IIH, 16 (72.8%) patients had severe and fulminant opening CSF pressures with values of more than 400 mmH(2)O. Among this group, 19 (86.4%) patients reported recovery of their headache and 16 (72.7%) patients showed complete resolution of papilledema. Shunt complications included two (9%) cases of shunt infection that required shunt extraction and antibiotic therapy, and six (27%) cases of shunt obstruction that required shunt revision. Manometric predictors for surgical treatment of IIH may include severe and fulminant opening CSF pressures as well as poor manometric response to repeated lumbar taps. Lumboperitoneal shunt is easy and effective for treating intractable headaches and visual impairment associated with IIH. Its usefulness can be optimized by meticulous technical placement of the shunt guided by rigorous protocols for shunt procedures.

Should Magnetic Resonance Venography be Performed Routinely in all Patients Undergoing Evaluation for Idiopathic Intracranial Hypertension?

Article

Nov 2015

Lumboperitoneal shunt for treatment of idiopathic intracranial hypertension

Article

Jan 2004

Use of lumboperitoneal shunts with the Strata NSC valve: A single-center experience

Article

Dec 2010

The lumboperitoneal (LP) shunt with the adjustable PS Medical Strata NSC LP valve and small lumen peritoneal catheter was introduced in the authors' unit in 2007. The object of this study was to audit the unit's experience with this new shunt system. The authors performed a retrospective review of the clinical records of patients who underwent Strata NSC LP shunt insertion. Demographic and clinical data as well as information about complications and revisions were reported. Between August 2007 and November 2009, 20 patients underwent placement of an LP shunt with an adjustable Strata NSC valve and small lumen peritoneal catheter at the authors' institution. Their mean age was 40.3 years and the mean duration of follow-up was 12 months. Preoperatively, 18 patients had headache and 15 patients had visual signs and symptoms. Fourteen of the 18 patients with preoperative headache did not complain of headache postoperatively, and 4 had headache that was found not to be related to shunt function. Two of the patients with preoperative visual complaints had ongoing visual problems postoperatively. None of the patients had infection or subdural hematoma. The only overdrainage symptoms occurred in association with spontaneous readjustment of the valve and resolved when the valve was reset. Thirteen patients (65%) did not require shunt revision. Seven patients (35%) required 13 shunt exploration or revision procedures, mainly due to distal obstruction. Placement of an LP shunt failed to completely resolve the raised intracranial pressure problem in 2 patients. The use of the Strata NSC valve and small lumen peritoneal catheter is effective in treating pseudotumor cerebri and is beneficial in terms of markedly reducing overdrainage complications compared with other reported series of cases in which an LP shunt has been placed. However, the use of the Strata NSC valve and small lumen peritoneal catheter did not have a marked impact on other causes of shunt failure, particularly distal obstruction.

Idiopathic intracranial hypertension

Article

Jul 2010
Br Med J

Kathleen Digre

Weight loss may be effective, but confirmation is needed from randomised trials In the linked prospective cohort study (doi:10.1136/bmj.c2701), Sinclair and colleagues observed intracranial pressure in patients with idiopathic intracranial hypertension who follow a low energy diet.1 This condition is often chronic and is characterised by symptoms and signs of intracranial hypertension, with no cause found by adequate imaging studies, and normal cerebrospinal fluid.2 Visual loss from papilloedema is the most feared visual complication.2 Headaches (which are difficult to treat) and depression are common, and quality of life is often reduced.3 4 Medical treatment of idiopathic intracranial hypertension consists of acetazolamide and other diuretics, which are thought to reduce the formation of cerebrospinal fluid.5 Because most affected people are obese, weight loss has been suggested. When visual loss occurs, surgical cerebrospinal fluid drainage procedures such as lumbar or ventriculo-peritoneal shunting or optic nerve sheath fenestration are performed. A recent systematic review found no randomised or controlled trials of treatment of the condition and called for such evidence.6 The risk of this condition …

Idiopathic intracranial hypertension in pediatric patients

Article

Jan 2009

To evaluate retrospectively the features, treatment, and outcome of idiopathic intracranial hypertension (IIH) in children. Nine patients, 15 years and younger, diagnosed with IIH. Inclusion criteria were papilledema, normal brain computer tomography or magnetic resonance imaging, cerebrospinal fluid pressure greater than 250 mm H(2)O, normal cerebrospinal fluid content, and a nonfocal neurologic examination except for sixth nerve palsy. Of the nine patients, eight were girls. Five girls were overweight and one boy was obese. The most common presenting symptom was headache (5 patients). Diplopia or strabismus did not occur in our group. Visual field abnormalities were present in all eyes, and severe visual loss resulting in light perception vision occurred in both eyes of one patient. Eight patients were treated medically with acetazolamide alone, and one girl needed a combination of acetazolamide and corticosteroids. This girl also required optic nerve sheath decompression surgery. Resolution of papilledema and recovery of visual function occurred in all patients. Idiopathic intracranial hypertension in prepubertal children is rather uncommon. Prompt diagnosis and management are important to prevent permanent visual loss.

Lumboperitoneal Shunt with No Valve or Antisiphon Device in Management of Idiopathic Intracranial Hypertension at The National Center of Neurological Sciences Among Sudanese Patients

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