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

Abstract
Background: Although lumboperitoneal shunt (LPS) is a common procedure for surgical management of idiopathic intracranial hypertension (IIH). However, many studies doc-umented a high failure and complications rate. Ventricular shunts were not commonly used for surgical management IIH due to the difficulty of inserting a shunt into normal or slit ventricles. Also, stereotactic surgery not available in every hospital.
Aim of the Study: This article retrospectively evaluate the accuracy, efficacy, and safety of using stereotactic image-guided insertion of ventricular catheter in patients with IIH.
Patients and Methods: The authors reviewed the clinical records of all patients in whom stereotaxy was used to guide the placement of a ventricular catheter for IIH. Stereotactic guided ventricular catheter placements were performed on sixteen patients presenting with clinical manifestation of IHH to target the frontal horn of the lateral ventricle after failure of traditional medical or previous surgical treatment. Results: We had fourteen females and two males. Their age ranged from 20 to 45 years (average 29.7). The mean follow-up period was 43.9 months (ranged from 10 to 84 months). Eleven patients had previous LPS insertion with at least one trial of revision. Five patients subjected to stereotactic VPS as a first procedure. Accurate ventricular catheter place-ment was done from the first trial in all patients which was confirmed on postoperative CT scan. Four patients underwent stereotactic ventriculo-atrial shunts due to decrease CSF absorptive capacity of peritoneal cavity due to multiple lumboperitoneal shunt revision. All patients showed improve-ment or stabilization of their visual manifestation after ven-tricular shunt insertion. Headache improved in fourteen patients whereas two patients still had headache that respond to medical treatment. We had no mortality and two patients required shunt revision.
Conclusions: Image-guided stereotactic ventricular cath-eter placement is an effective, safe and durable management option that can help in management of IIH when the ordinary medical and surgical methods fail. Also it may be the first choice in certain selected cases.