Table 2.
Outcomes and complications of CSF diversion in IIH
| Studies | Type of diversion | Number of cases | Follow-up (months) | Clinical outcomes
|
Revision rate and complication | |||
|---|---|---|---|---|---|---|---|---|
| Headache | Visual acuity | Visual field | Papilledema | |||||
| Fonseca et al90 | VPS (37%) VAS (63%) |
19 | 34 | NR | 47% improved, 32% stable, 21% worsened | Improvement of mean deviation from −15.80 to −9.23 dB | 87% complete resolution 13% stable at grade 1 |
Revision rate =42% Complications: shunt infection (5%) |
| Huang et al119 | VPS | 17 | 21 | Overall outcomes were 53% improved, 29% s table, 6% worsened, and 12% indeterminate Statistical improvement of VA on both eyes, but no significant improvement of VF | Nonfunctioning VPS 20%, 35%, and 53% at 1, 2, and 3 years, respectively | |||
| Yadav et al88 | LPS | 24 | 51 | 92% improved | 56% improved, 27% stable, and 17% worsened in VA No data on VF or papilledema outcomes | Revision rate =8% Complications: overdrainage (63%) |
||
| Sinclair et al89 | LPS (92%) VPS (8%) |
53 | 24 | 32%, 23%, and 21% remission at 6, 12, and 24 months, respectively | Significant improvement at 6 and 12 months (not at 24 months) | No significant improvement | Resolution 35%, 52%, and 56% at 6, 12, and 24 months, respectively | Revision rate =51% within 7.5 months in average and 85% within 1 year Complications: obstruction (44%), disconnection (19%), and migration (7%) |
| Tarnaris et al84 | LPS (83%) VPS (17%) |
29 | 29 | 71% improved in LPS 60% improved in VPS |
42% improved in LPS 40% improved in VPS |
NR | NR | Revision rate =40% in LPS and 22% in VPS within 14.3 months in average Complications: 24% in LPS and 11% in VPS (shunt infection, obstruction, overdrainage, and migration) |
| No significant difference between groups | ||||||||
| Abubaker et al86 | LPS (72%) VPS (28%) |
25 | 48 | 83% improved in LPS 90% improved in VPS |
91% improved in LPS 100% improved in VPS |
100% improved in LPS 100% improved in VPS |
88% improved in LPS 86% improved in VPS |
Revision rate =60% in LPS and 30% in VPS within 7 months in average Complications: migration, obstruction, shunt infection, and overdrainage in LPS. Chronic subdural hematoma in VPS |
| Ushewokunze et al120 | LSS | 23 | 24 | 57% had only transient improvement which subsequently required VPS/LPS 44% had sustained and permanent improvement, required no further intervention |
Complications: overdrainage (65%), back pain and sciatica (39%), CSF leak (13%) | |||
| McGirt et al85 | LPS (69%)VPS/VAS (31%) | 42 | 49 | 95% improved immediately with recurrent headache in 19% by 12 months and 48% by 36 months Risk factors for recurrence of headache were papilledema (RR: 5.2) and long-term symptoms (RR: 2.5) |
Risk of revision increased 2.5-fold in LPS compared with VPS/VAS Shunt obstruction was 2.5-fold higher in LPS. Similar risks of overdrainage, migration, and infection between LPS and VPS/VAS |
|||
Abbreviations: CSF, cerebrospinal fluid; IIH, idiopathic intracranial hypertension; VPS, ventriculoperitoneal shunt; VAS, ventriculoatrail shunt; NR, not reported; VA, visual acuity; VF, visual field; LPS, lumboperitoneal shunt; LSS, lumbar subcutaneous shunt; RR, relative risk.