分流术对特发性颅内高压患者的视力结局和头痛的影响。

Effect of Shunting on Visual Outcomes and Headache in Patients with Idiopathic Intracranial Hypertension.

机构信息

Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.

Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.

出版信息

World Neurosurg. 2020 Oct;142:e73-e80. doi: 10.1016/j.wneu.2020.05.186. Epub 2020 May 29.

DOI:10.1016/j.wneu.2020.05.186

PMID:32474095

Abstract

BACKGROUND

Visual dysfunction and headache are major symptoms in patients with idiopathic intracranial hypertension (IIH). We aimed to evaluate the improvement of these symptoms in patients who underwent ventriculoperitoneal (VPS) and lumboperitoneal (LPS) shunting.

METHODS

Electronic medical records were reviewed to identify baseline and treatment characteristics for patients diagnosed with IIH over 10 years. Visual outcomes and headache were evaluated at the latest follow-up post shunting.

RESULTS

We included 163 patients with a mean age of 32.6 years. Most patients (74.2%) underwent VPS versus 25.8% of patients who received LPS. After a mean follow-up duration of 35 months, there was a 58.3% decrease in patients reporting headache (P = 0.006), an 87.7% decrease in papilledema (P = 0.1), a 100% resolution of diplopia with VPS or LPS, and an 88.5% decrease in transient visual obscurations (P = 1). In the worse eye, improved visual acuity (VA) occurred in 53.7% of eyes (P = 1), was stable in 16.4%, and worsened in 29.8%. The mean LogMAR VA was improved by 0.06 LogMAR (20/68) in the worse eye (P = 0.97) and 0.08 LogMAR (20/31) in the better eye (P = 0.7). The visual function that impairs daily activity was decreased by 55.4% (P = 0.08). Patients shunted within 1 month of presentation had a significantly higher rate of headache (P = 0.04) and VA improvement (P < 0.001).

CONCLUSIONS

VPS and LPS are effective in improving visual symptoms and headache in patients with IIH.

摘要

背景

视觉功能障碍和头痛是特发性颅内高压（IIH）患者的主要症状。我们旨在评估脑室腹膜（VPS）和腰椎腹膜（LPS）分流术对这些症状的改善。

方法

回顾性分析了 10 多年来诊断为 IIH 的患者的基线和治疗特征的电子病历。在分流术后的最新随访中评估视觉结果和头痛。

结果

我们纳入了 163 名平均年龄为 32.6 岁的患者。大多数患者（74.2%）接受了 VPS，而 25.8%的患者接受了 LPS。平均随访 35 个月后，报告头痛的患者减少了 58.3%（P=0.006），视乳头水肿减少了 87.7%（P=0.1），VPS 或 LPS 可完全缓解复视，一过性视力模糊减少了 88.5%（P=1）。在最差的眼睛中，视力（VA）改善的发生率为 53.7%（P=1），稳定的为 16.4%，恶化的为 29.8%。最差眼的平均 LogMAR VA 提高了 0.06 LogMAR（20/68）（P=0.97），最佳眼提高了 0.08 LogMAR（20/31）（P=0.7）。影响日常生活的视觉功能下降了 55.4%（P=0.08）。在出现后 1 个月内接受分流术的患者头痛（P=0.04）和 VA 改善（P<0.001）的发生率显著更高。