TY - JOUR
T1 - Outcomes and Experience with Lumbopleural Shunts in the Management of Idiopathic Intracranial Hypertension
AU - Elder, Benjamin D.
AU - Sankey, Eric W.
AU - Goodwin, C. Rory
AU - Jusué-Torres, Ignacio
AU - Khattab, Mohamed H.
AU - Rigamonti, Daniele
N1 - Funding Information:
We thank the Salisbury Family Foundation, the Swenson Family Foundation, the UNCF-Merck Postdoctoral Fellowship, and the Burroughs Wellcome Fund for their generous support. We would like to acknowledge Ikumi Kayama for providing the medical illustration for this manuscript. Additionally, this manuscript reflects the views of the authors and should not be construed to represent the Food and Drug Administration's views or policies.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Objective To report five patients who underwent lumbopleural (LPl) shunting for the treatment of idiopathic intracranial hypertension (IIH) and to describe the considerations, complications, and outcomes related to this rarely described procedure. Methods The clinical data of five patients treated with LPl shunting over a 23-year period were retrospectively analyzed. Factors including the age at diagnosis of IIH, age at time of LPl shunting, body mass index (BMI), reason for LPl shunt placement, number of revisions before LPl shunt placement, valve type, time to first revision, presence of overdrainage and its management, complications and their management, survival time of LPl shunt, and clinical course at last follow-up were analyzed. Results All patients were morbidly obese females with an average of 4.6 shunt revisions before an LPl shunt. The average overall survival time of the LPl shunt was 48 months. Two patients experienced failure of their LPl shunts with subsequent replacement within the first year. Four patients experienced complications related to shunt overdrainage, requiring placement of an antisiphon device (ASD) or additional valve. One patient developed a symptomatic pleural effusion, and one patient developed a small pneumothorax, which was managed conservatively. Conclusions LPl shunting, though rarely used, is a viable option in the treatment of IIH refractory to standard peritoneal shunting. When pursuing this treatment, a valve and ASD are recommended to mitigate the risks of overdrainage and pleural effusion. Chest imaging should be obtained if the patient becomes symptomatic but can be deferred if the patient remains asymptomatic and is doing well.
AB - Objective To report five patients who underwent lumbopleural (LPl) shunting for the treatment of idiopathic intracranial hypertension (IIH) and to describe the considerations, complications, and outcomes related to this rarely described procedure. Methods The clinical data of five patients treated with LPl shunting over a 23-year period were retrospectively analyzed. Factors including the age at diagnosis of IIH, age at time of LPl shunting, body mass index (BMI), reason for LPl shunt placement, number of revisions before LPl shunt placement, valve type, time to first revision, presence of overdrainage and its management, complications and their management, survival time of LPl shunt, and clinical course at last follow-up were analyzed. Results All patients were morbidly obese females with an average of 4.6 shunt revisions before an LPl shunt. The average overall survival time of the LPl shunt was 48 months. Two patients experienced failure of their LPl shunts with subsequent replacement within the first year. Four patients experienced complications related to shunt overdrainage, requiring placement of an antisiphon device (ASD) or additional valve. One patient developed a symptomatic pleural effusion, and one patient developed a small pneumothorax, which was managed conservatively. Conclusions LPl shunting, though rarely used, is a viable option in the treatment of IIH refractory to standard peritoneal shunting. When pursuing this treatment, a valve and ASD are recommended to mitigate the risks of overdrainage and pleural effusion. Chest imaging should be obtained if the patient becomes symptomatic but can be deferred if the patient remains asymptomatic and is doing well.
KW - Hydrocephalus
KW - Idiopathic intracranial hypertension
KW - Lumbopleural shunt
KW - Pseudotumor cerebri
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U2 - 10.1016/j.wneu.2015.03.021
DO - 10.1016/j.wneu.2015.03.021
M3 - Article
C2 - 25805534
AN - SCOPUS:84938993171
SN - 1878-8750
VL - 84
SP - 314
EP - 319
JO - World neurosurgery
JF - World neurosurgery
IS - 2
ER -