Image-Guided Stereotactic Ventricular Catheter Placement for Refractory Idiopathic Intracranial Hypertension: Accuracy and Effectiveness

Abstract
Background: Although lumboperitoneal shunt (LPS) is acommon procedure for surgical management of idiopathicintracranial hypertension (IIH). However, many studies doc-umented a high failure and complications rate. Ventricularshunts were not commonly used for surgical management IIHdue to the difficulty of inserting a shunt into normal or slitventricles. Also, stereotactic surgery not available in everyhospital.
Aim of the Study: This article retrospectively evaluate theaccuracy, efficacy, and safety of using stereotactic image-guided insertion of ventricular catheter in patients with IIH.
Patients and Methods: The authors reviewed the clinicalrecords of all patients in whom stereotaxy was used to guidethe placement of a ventricular catheter for IIH. Stereotacticguided ventricular catheter placements were performed onsixteen patients presenting with clinical manifestation of IHHto target the frontal horn of the lateral ventricle after failureof traditional medical or previous surgical treatment.
Results: We had fourteen females and two males. Theirage ranged from 20 to 45 years (average 29.7). The meanfollow-up period was 43.9 months (ranged from 10 to 84months). Eleven patients had previous LPS insertion with atleast one trial of revision. Five patients subjected to stereotacticVPS as a first procedure. Accurate ventricular catheter place-ment was done from the first trial in all patients which wasconfirmed on postoperative CT scan. Four patients underwentstereotactic ventriculo-atrial shunts due to decrease CSFabsorptive capacity of peritoneal cavity due to multiplelumboperitoneal shunt revision. All patients showed improve-ment or stabilization of their visual manifestation after ven-tricular shunt insertion. Headache improved in fourteen patientswhereas two patients still had headache that respond to medicaltreatment. We had no mortality and two patients requiredshunt revision.
Conclusions: Image-guided stereotactic ventricular cath-eter placement is an effective, safe and durable managementoption that can help in management of IIH when the ordinarymedical and surgical methods fail. Also it may be the firstchoice in certain selected cases.