1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah; and.
2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
J Neurosurg. 2019 Jan 1;130(1):136-144. doi: 10.3171/2017.8.JNS162927. Epub 2018 Feb 2.
OBJECTIVE Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a complex and difficult-to-manage condition that can lead to permanent vision loss and refractory headaches if untreated. Traditional treatment options, such as unilateral ventriculoperitoneal (VP) or lumboperitoneal (LP) shunt placement, have high complication and failure rates and often require multiple revisions. The use of bilateral proximal catheters has been hypothesized as a method to improve shunt survival. The use of stereotactic technology has improved the accuracy of catheter placement and may improve treatment of IIH, with fewer complications and greater shunt patency time. METHODS The authors performed a retrospective chart review for all patients with IIH who underwent stereotactic placement of biventriculoperitoneal (BVP) shunt catheters from 2008 to 2016 at their institution. Bilateral proximal catheters were Y-connected to a Strata valve with a single distal catheter. We evaluated clinical, surgical, and ophthalmological variables and outcomes. RESULTS Most patients in this series of 34 patients (mean age 34.4 ± 8.2 years, mean body mass index 38.7 ± 8.3 kg/m2; 91.2% were women) undergoing 41 shunt procedures presented with headache (94.1%) and visual deficits (85.3%). The mean opening pressure was 39.6 ± 9.0 cm H2O. In addition, 50.0% had undergone previous unilateral shunt placement, and 20.6% had undergone prior optic nerve sheath fenestration. After BVP shunt placement, there were no cases of proximal catheter obstruction and only a single case of valve obstruction at 41.9 months, with a mean follow-up of 24.8 ± 20.0 months. Most patients showed improvement in their headache (82.4%), subjective vision (70.6%), and papilledema (61.5% preoperatively vs 20.0% postoperatively, p = 0.02) at follow-up. Additional primary complications included 4 patients with migration of their distal catheters out of the peritoneum (twice in 1 patient), and an infection of the distal catheter after catheter dislodgment. The proximal obstructive shunt complication rate in this series (2.9%) was lower than that with LP (53.5%) or unilateral VP (37.8%) shunts seen in the literature. CONCLUSIONS This small series suggests that stereotactic placement of BVP shunt catheters appears to improve shunt survival rates and presenting symptoms in patients with IIH. Compared with unilateral VP or LP shunts, the use of BVP shunts may be a more effective and more functionally sustained method for the treatment of IIH.
目的 特发性颅内高压（IIH）或假性脑瘤是一种复杂且难以治疗的疾病，如果不治疗，可能导致永久性视力丧失和难治性头痛。传统的治疗选择，如单侧脑室腹膜（VP）或腰腹膜（LP）分流术，具有较高的并发症和失败率，并且经常需要多次修订。使用双侧近端导管已被假设为提高分流术存活率的一种方法。立体定向技术的使用提高了导管放置的准确性，并可能通过减少并发症和增加分流术通畅时间来改善 IIH 的治疗效果。 方法 作者对 2008 年至 2016 年间在他们的机构接受立体定向放置双脑室腹膜（BVP）分流导管的所有 IIH 患者进行了回顾性图表审查。双侧近端导管通过 Y 形连接到 Strata 阀，带有单个远端导管。我们评估了临床、手术和眼科变量及结果。 结果 在这一系列 34 例患者（平均年龄 34.4 ± 8.2 岁，平均体重指数 38.7 ± 8.3 kg/m2；91.2%为女性）中，大多数患者（94.1%）出现头痛和视觉障碍（85.3%）。平均开放压力为 39.6 ± 9.0 cm H2O。此外，50.0%的患者曾行单侧分流术，20.6%的患者曾行视神经鞘开窗术。BVP 分流术后，近端导管阻塞无病例，仅 1 例在 41.9 个月时出现阀门阻塞，平均随访时间为 24.8 ± 20.0 个月。大多数患者头痛（82.4%）、主观视力（70.6%）和视乳头水肿（术前 61.5%，术后 20.0%，p = 0.02）均有改善。其他主要并发症包括 4 例患者的远端导管迁移出腹膜（1 例中发生 2 次）和导管脱位后远端导管感染。与文献中所见的 LP（53.5%）或单侧 VP（37.8%）分流术相比，本系列中近端阻塞性分流术的并发症发生率（2.9%）较低。 结论 这项小系列研究表明，立体定向放置 BVP 分流导管似乎可以提高 IIH 患者的分流术存活率和现有的症状。与单侧 VP 或 LP 分流术相比，BVP 分流术可能是治疗 IIH 的一种更有效、更持久的方法。
