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Review
. 2024 Feb 22;166(1):98.
doi: 10.1007/s00701-024-05985-4.

Ventriculo-atrial shunt in idiopathic intracranial hypertension

Sheikh M B Momin  1   2 , Sophie R Mullins  3 , Claudia L Craven  3   4 , Laurence Watkins  3 , Ahmed K Toma  3
Affiliations
Review

Ventriculo-atrial shunt in idiopathic intracranial hypertension

Sheikh M B Momin et al. Acta Neurochir (Wien). .

Abstract

Purpose: CSF diversion is a recognised intervention in idiopathic intracranial hypertension (IIH), particularly in the presence of vision-threatening papilledema. Although ventriculo-atrial (VA) shunt insertion is a routine neurosurgical procedure, ventriculoperitoneal and lumboperitoneal shunts have been mostly used in this particular indication. This study aims to look at a single centre's experience with VA shunts in idiopathic intracranial hypertension (IIH).

Methods: Retrospective case series with a review of electronic records over a 10-year period; exclusion criteria were duplication of same shunt insertion, no VA shunt insertion, paediatric patients and indication other than IIH. Notes were reviewed for demographics, shunt survival (defined by time prior to revision) and reasons for revision.

Results: Eight VA shunt procedures were identified in 6 patients (mean age at insertion 34 ± 10 years) with a mean follow-up of 58 ± 25 months. All shunts were secondary procedures; 2 revisions from lumbo-pleural, 2 from ventriculopleural, 2 from ventriculoatrial and one each from ventriculoperitoneal and combined lumbo-/ventriculoperitoneal. At 50 months, 75% of VA shunts had survived, compared to only 58.3% of VPleural shunts in patients with IIH. Revisions were required due to acute intracranial bleed (1 case)-revised at day 1, and thrombus at distal site (1 case)-revised at day 57. Both shunts were later reinserted. From the latest clinic letters, all patients had their treatment optimised with this procedure, although only two patients had documented resolved papilloedema post-procedure.

Conclusions: Ventriculo-atrial shunts are a safe and efficacious alternative option for CSF diversion in IIH. In this series, only 1 shunt was revised for a VA shunt-specific complication.

Keywords: CSF; Hydrocephalus; Idiopathic intracranial hypertension; Shunt; Ventriculo-atrial shunt.

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Conflict of interest statement

AKT’s research time was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. LDW has received honoraria from and served on advisory boards for Medtronic, B. Braun and Codman. SM is an NIHR-funded Academic Clinical Fellow.

Figures

Fig. 1
Fig. 1
The Kaplan–Meier survival curve for VA shunts in our series (n = 8). Created with GraphPad Prism 6.0c
See this image and copyright information in PMC

References

    1. Portelli M, Papageorgiou PN (2017) An update on idiopathic intracranial hypertension. Acta Neurochir (Wien) 159(3):491–499 - PubMed
    1. Smith JL (1985) Whence pseudotumor cerebri? J Clin Neuroophthalmol 5(1):55–56 - PubMed
    1. Biousse V, Bruce BB, Newman NJ (2012) Update on the pathophysiology and management of idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatr 83(5):488–494 - PMC - PubMed
    1. Kilgore KP, Lee MS, Leavitt JA, Mokri B, Hodge DO, Frank RD, Chen JJ (2017) Re-evaluating the incidence of idiopathic intracranial hypertension in an era of increasing obesity. Ophthalmology 124(5):697–700 - PMC - PubMed
    1. Radhakrishnan K, Thacker AK, Bohlaga NH, Maloo JC, Gerryo SE (1993) Epidemiology of idiopathic intracranial hypertension: a prospective and case-control study. J Neurol Sci 116(1):18–28 - PubMed

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