Document Detail


Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review.
MedLine Citation:
PMID:  21968519     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The role of cerebrospinal fluid (CSF) diversion in treating idiopathic intracranial hypertension (IIH) is disputed.
METHOD: We conducted a 10-year, retrospective case note review to evaluate the effects of CSF diversion in IIH. Symptoms, signs and details of shunt type, complications and revisions were documented at baseline, 6, 12 and 24 months post-operatively.
RESULTS: Fifty-three IIH patients were shunted [predominantly lumboperitoneal (92%)]. The most common symptom pre-surgery was headache (96%). Post-operatively, significantly fewer patients experienced declining vision and visual acuity improved at 6 (p = 0.001) and 12 months (p = 0.016). Headache continued in 68% at 6 months, 77% at 12 months and 79% at 2 years post-operatively. Additionally, post-operative low-pressure headache occurred in 28%. Shunt revision occurred in 51% of patients, with 30% requiring multiple revisions.
CONCLUSION: We conclude that CSF diversion reduces visual decline and improves visual acuity. Unfortunately, headache remained in the majority of patients and low-pressure headache frequently complicated surgery. Over half of the patients required shunt revision with the majority of these requiring multiple revisions. We suggest that CSF shunting should be conducted as a last resort in those with otherwise untreatable, rapidly declining vision. Alternative treatments, such as weight reduction, may be more effective with less associated morbidity.
Authors:
Alexandra J Sinclair; Sarin Kuruvath; Diptasri Sen; Peter G Nightingale; Michael A Burdon; Graham Flint
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-10-03
Journal Detail:
Title:  Cephalalgia : an international journal of headache     Volume:  31     ISSN:  1468-2982     ISO Abbreviation:  Cephalalgia     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-19     Completed Date:  2012-04-03     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  8200710     Medline TA:  Cephalalgia     Country:  England    
Other Details:
Languages:  eng     Pagination:  1627-33     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebrospinal Fluid Shunts / adverse effects,  statistics & numerical data*
Female
Humans
Male
Pseudotumor Cerebri / surgery*
Reoperation / statistics & numerical data
Retrospective Studies
Grant Support
ID/Acronym/Agency:
G0601430//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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