Lumboperitoneal Shunt with No Valve or Antisiphon Device in Management of Idiopathic Intracranial Hypertension at The National Center of Neurological Sciences Among Sudanese Patients
Yousif Ahmed Abdellatief, MD1, Bashier Mohammed Bashier, MD2 and Emad Ibrahim Ahmed, MD3*
1Department of neurosurgery, National centre for neurological sciences (NCNS), Khartoum, Sudan, 00249910565114
2Department of neurosurgery, National centre for neurological sciences (NCNS), Khartoum, Sudan, 00249912163251
3Assistant professor of neurosurgery, Sudan university of science and technology, Department of surgery, Khartoum, Sudan, 0024919000052
*Corresponding Author: Emad Ibrahim Ahmed, Assistant professor of neurosurgery, Sudan university of science and technology, Department of surgery, Khartoum, Sudan.
Received: October 16, 2022 Published: November 03, 2022
Abstract
Background: Surgical treatment of idiopathic intracranial hypertension includes cerebrospinal fluid diversion procedures most commonly lumboperitoneal shunt. Lumboperitoneal shunt addresses the cause of both headache and papilledema more directly by effecting a global reduction of intracranial pressure.
Objective: To study surgical outcome of lumboperitoneal shunt in management of idiopathic intracranial hypertension.
Methods: This is retrospective study conducted at The NCNS (January 2017– June 2019). All patients diagnosed with IIH and operated by LP shunt with no valve or antisiphon device were included in this study. The data was inserted in a designed Excel sheet and the data analysis was conducted using Statistical Packages for Social Sciences version 23.
Results: The number of patients was 22 patients. (90.9%) less than 40 years. Male to female ratio was 1:10. Presenting symptoms and signs were papilledema (100.0%), headache (95.5%), blurring of vision (72.7%), diplopia (4.5%), vomiting (18.2%), convulsion (4.5%), neck pain (4.5%), hypoesthesia on the face (4.5%), these features subsided in (66.7%), (85.7%), (57.1%) and (100.0%) for the remainder symptoms, respectively. Blindness (27.3%) and optic atrophy (54.5%) did not subside in affected cases, one case lost follow up. Operative site pain with radiculopathy in one case, subsided without intervention. Radiological images of the brain were unremarkable except in one case diagnosed with sinus thrombosis and managed with warfarin. No cognitive or motor deficit was reported. One case of convulsion was controlled with medication. Reduction in weight associated with visual improvement was reported in only one patient who lost 14kg after operation. Surgical revision was done for 27.3%. The causes for revision involved shunt malfunction, CSF leakage, slippage of catheter either from lumbar or abdominal part which may be associated with migration.
Conclusion: IIH is a serious disease with variable symptoms and signs related to high ICP and can progress to irreversible visual loss. Lumboperitoneal shunt (LP) operation is a very effective surgical procedure in management of IIH. Meticulous technique during insertion of the LP catheter is very crucial so as to optimize the efficacy of the operation and decrease the failure rate.
Keywords: lumboperitoneal shunt, surgical outcome, idiopathic intracranial hypertension
Citation: Abdellatief YA, Bashier BM, Ahmed EI. “Lumboperitoneal Shunt with No Valve or Antisiphon Device in Management of Idiopathic Intracranial Hypertension at The National Center of Neurological Sciences Among Sudanese Patients”. SVOA Neurology 2022, 3:6, 236-245.
