Bjornson Anna, Tapply Ian, Nabbanja Eva, Lalou Afrodite-Despina, Czosnyka Marek, Czosnyka Zofia, Muthusamy Brinda, Garnett Matthew
a Department of Neurosurgery , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK.
b Department of Ophthalmology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK.
Br J Neurosurg. 2019 Feb;33(1):62-70. doi: 10.1080/02688697.2018.1538478. Epub 2019 Jan 17.
To determine the outcome of ventriculo-peritoneal shunts as a treatment for idiopathic intracranial hypertension (IIH) Materials and Methods: Retrospective case series of 28 patients with IIH and evidence of raised intracranial pressure (ICP) who underwent shunt insertion. Patients were identified from a prospectively updated operative database. A case-notes review was performed and data on type of shunt, pre- and post-operative symptoms, ophthalmological findings and post-operative complications were recorded.
All patients had symptoms of IIH that had failed medical management. Twelve patients had previous lumbo-peritoneal shunts and 2 patients had previous venous sinus stents. All patients had evidence of raised ICP as papilloedema and raised CSF pressure on lumbar puncture. Twenty-seven patients received a ventriculo-peritoneal shunt and 1 patient a ventriculo-atrial shunt. Twenty-six patients received Orbis Sigma Valves and 2 patients Strata valves. At follow-up all patients (100%) had improvement/resolution of papilloedema, 93% had improved visual acuity and 84% had improved headaches. Mean time to last follow-up was 15 (range 4-96) months. Complications occurred in 3 patients (11%): 2 patients required revision of their peritoneal catheters and 1 patient had an anti-siphon device inserted.
Previous literature reported a ventricular shunt revision rate of 22-42% in the management of IIH. We demonstrate ventriculo-peritoneal shunts to be an effective treatment with a revision rate of 11% compared to the previously reported 22-42%.
确定脑室 - 腹腔分流术治疗特发性颅内高压（IIH）的疗效。材料与方法：对28例IIH且有颅内压（ICP）升高证据并接受分流管置入术的患者进行回顾性病例系列研究。患者从一个前瞻性更新的手术数据库中识别出来。进行病例记录回顾，并记录分流管类型、术前和术后症状、眼科检查结果及术后并发症的数据。
所有患者均有经药物治疗无效的IIH症状。12例患者曾行腰 - 腹腔分流术，2例患者曾行静脉窦支架置入术。所有患者均有ICP升高的证据，表现为视乳头水肿和腰椎穿刺时脑脊液压力升高。27例患者接受了脑室 - 腹腔分流术，1例患者接受了脑室 - 心房分流术。26例患者接受了Orbis Sigma瓣膜，2例患者接受了Strata瓣膜。随访时，所有患者（100%）视乳头水肿均有改善/消退，93%的患者视力提高，84%的患者头痛改善。最后一次随访的平均时间为15（4 - 96）个月。3例患者（11%）出现并发症：2例患者需要更换腹腔导管，1例患者植入了抗虹吸装置。
既往文献报道在IIH治疗中脑室分流术的翻修率为22% - 42%。我们证明脑室 - 腹腔分流术是一种有效的治疗方法，翻修率为11%，而之前报道的翻修率为22% - 42%。
