Background: Lumboperitoneal
shunting is the mainstay of neurosurgical management for idiopathic
intracranial hypertension. However, recent studies document a high failure rate
and complications for this procedure. Ventriculoperitoneal shunts have not been
widely used for idiopathic intracranial hypertension because of the difficulty
of placing a shunt into normal or small-sized ventricles. Objective: The
article aims to evaluate the implication of using stereotactic image–guided
ventricular catheter placement in patients with idiopathic intracranial
hypertension as an alternative to lumboperitoneal shunting and to assess its
outcome. Methods: Stereotactic
ventricular catheter placements were performed on eight patients presenting
with signs and symptoms of idiopathic intracranial hypertension that was
refractory to traditional medical and surgical treatment. Results: All
patients underwent ventricular catheter placement using stereotactic
image-guided technology. All patients were cannulated with a single pass, and
satisfactory catheter placement was confirmed on a postoperative CT scan with
concordant patient’s symptoms improvement. All of the patients improved
clinically at the last follow-up compared to their preoperative condition. None
of the patients experienced intra- or perioperative complications. Two of them
underwent stereotactic ventriculoatrial shunts due to defective CSF absorption
following multiple lumboperitoneal shunt revision. Conclusions: By
reviewing literatures and analyzing our results, we conclude that stereotactically
guided ventricular catheter placement is an effective and durable treatment
option in many cases of idiopathic intracranial hypertension that are
refractory to the traditional medical and surgical approaches. [Egypt J Neurol
Psychiat Neurosurg. 2012; 49(1): 75-80]
Key Words:
Idiopathic intracranial hypertension, benign intracranial hypertension,
pseudotumor cerebri, stereotactic ventriculoperitoneal shunt.
Correspondence to Ahmed Shakal, Department of
Neurosurgery, Tanta
University.Tel.: +201111494111 E-mail: ahmedshakal@med.tanta.edu.eg