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Cerebrospinal fluid diversion procedures in pseudotumor cerebri
M L Rosenberg1, J J Corbett, C Smith
1Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799.
Neurology
|June 1, 1993
Summary
Cerebrospinal fluid (CSF) diversion for pseudotumor cerebri (PTC) shows high shunt failure and complication rates. Many patients require multiple surgeries, and vision outcomes are variable despite interventions.
Area of Science:
- Neurosurgery
- Ophthalmology
Background:
- Pseudotumor cerebri (PTC), also known as idiopathic intracranial hypertension, is a condition characterized by increased intracranial pressure.
- Cerebrospinal fluid (CSF) diversion via shunts is a common treatment for PTC, aiming to reduce intracranial pressure and preserve vision.
Purpose of the Study:
- To evaluate the long-term efficacy and complication rates of CSF diversion procedures for treating pseudotumor cerebri (PTC).
- To analyze factors contributing to shunt failure and impact on visual outcomes in PTC patients.
Main Methods:
- Retrospective review of 37 patients with PTC undergoing 73 lumboperitoneal shunts and 9 ventricular shunts across six institutions.
- Analysis of shunt survival rates, reasons for reoperation, and changes in visual acuity postoperatively.
Main Results:
- Only 14% of patients achieved resolution after a single shunt procedure, with 64% of shunts failing within 6 months.
- Common reoperation causes included shunt failure (55%) and low-pressure headaches (21%).
- While most patients experienced vision improvement or stabilization, some suffered vision loss or deterioration, even with functioning shunts.
Conclusions:
- CSF diversion for PTC is associated with significant shunt failure rates and frequent side effects.
- The high rate of complications and variable visual outcomes underscore the need for careful patient selection and monitoring.