Complications of Lumboperitoneal Shunts for Idiopathic Intracranial Hypertension

Abstract

For the past half century, the mainstay of cerebrospinal fluid (CSF) shunting for idiopathic intracranial hypertension (IIH) has been lumboperitoneal (LP) shunt surgery. LP shunts have been associated with higher failure rates compared to ventriculoperitoneal shunts. However, there is no uniformity in the reporting of complication and surgical revision rates. The goals of this study were to understand better the complications and surgical revision rates associated with LP shunt insertion in IIH patients with the objective of providing better information about the different therapeutical option outcomes when counseling for a better informed consent. Twenty-six patients with IHH undergoing lumboperitoneal shunt surgery for the first time by the senior author at an academy tertiary-care institution were retrospectively reviewed. Presence of complications and surgical revisions were the two main outcome variables. Logistic regression analysis was used first to assess if there was a correlation between preoperative patient characteristics and complications and second to evaluate if there was any association between preoperative patient characteristics or postsurgical complications and surgical revision. Primary shunts were inserted into 26 patients and 58% required revision surgery. Median time to surgical revision was four (3-22) months. Multivariate logistic analysis showed no statistical significant association between preoperative patient characteristics and postoperative complications as well as no relationship between either preoperative characteristics or complications and surgical revisions. Our data suggests that our revisions were mostly performed to reduce the rate of post-LP shunt tonsillar herniation. The introduction of newer hardware is expected to positively impact the symptoms and signs of overdrainage post-LP shunt placement and the need for revision.