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Cerebrospinal Fluid Shunting for Idiopathic Intracranial Hypertension: A Systematic Review, Meta-Analysis, and
Mira Salih1, Alejandro Enriquez-Marulanda1, MirHojjat Khorasanizadeh1
1Neurosurgical Service, Harvard Medical School, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Boston, Massachusetts, USA.
Insights
Cerebrospinal fluid (CSF) shunting significantly improves symptoms in idiopathic intracranial hypertension (IIH). While effective, CSF shunting has a high revision rate and potential for low-pressure headaches.
Area of Science:
- Neurosurgery
- Neurology
- Ophthalmology
Background:
- Cerebrospinal fluid (CSF) shunting is a common treatment for refractory idiopathic intracranial hypertension (IIH).
- Existing reviews compare shunting to other surgical options, but lack detailed clinical outcome analysis.
- This study focuses specifically on the clinical outcomes following CSF shunting in IIH patients.
Purpose of the Study:
- To perform a meta-analysis on the clinical impact of CSF shunting for medically refractory IIH.
- To integrate findings with other treatment data for a modern management protocol.
Main Methods:
- Systematic literature search of PubMed and Embase for CSF shunting in refractory IIH.
- Meta-analysis of study characteristics, patient demographics, clinical outcomes, and complications.
- Inclusion of 15 studies with 372 patients published between 1988 and 2019.
Main Results:
- Significant symptom improvement: 91% for headache, 96% for papilledema, 85% for visual impairment.
- High overall revision rate of 42% (155/372 patients requiring 436 revisions).
- Periprocedural low-pressure headaches occurred in 20% of patients, with no correlation between follow-up duration and revision rates.
Conclusions:
- CSF shunting demonstrates significant clinical symptom improvement in IIH patients.
- Overdrainage-related low-pressure headache is the primary periprocedural complication.
- A notable high revision rate necessitates careful consideration in management protocols.
Background:
Cerebrospinal fluid (CSF) shunting is widely used in refractory idiopathic intracranial hypotension (IIH). Although multiple reviews have assessed its efficacy compared with other surgical treatments, there is no detailed analysis that evaluates the clinical outcomes after CSF shunting.
Objective:
To conduct a meta-analysis of the clinical impact of CSF shunting for refractory IIH and use this in conjunction with existing information on other treatment modalities to develop a modern management protocol.
Methods:
PubMed and Embase were systematically searched for studies describing CSF shunting for medically refractory IIH. Relevant information including study characteristics, patient demographics, clinical outcomes, periprocedural complications, and long-term outcomes were subjected to meta-analysis.
Results:
Fifteen studies published between 1988 and 2019 met our inclusion and exclusion criteria, providing 372 patients for analysis. The mean age was 31.2 years (range 0.5-71) with 83.6% being female. The average follow-up was 33.9 months (range 0-278 months). The overall rate of improvement in headache, papilledema, and visual impairment was 91% (95% CI 84%-97%), 96% (95% CI 85%-100%), and 85% (95% CI 72%-95%), respectively. Of 372 patients, 155 had 436 revisions; the overall revision rate was 42% (95% CI 26%-59%). There was no significant correlation between average follow-up duration and revision rates in studies ( P = .627). Periprocedural low-pressure headaches were noted in 74 patients (20%; 95% CI 11%-32%).
Conclusion:
CSF shunting for IIH is associated with significant improvement in clinical symptoms. Shunting rarely causes periprocedural complications except overdrainage-related low-pressure headache. However, CSF shunting has a relatively high revision rate.
