Image Guided Ventriculoperitoneal Shunt Vs. Standard Revision of Lumboperitoneal Shunt For Management of Failed Lumboperitoneal Shunt in Idiopathic Intracranial Hypertension Patients
Keywords:
Idiopathic intracranial hypertension, Ventriculoperitoneal shunt, Lumboperitoneal shunt, Shunt failure, Image-guided surgery, Neuronavigation, Shunt revision, Cerebrospinal fluid diversion.Abstract
Background: Idiopathic intracranial hypertension may require surgical cerebrospinal fluid diversion, with image-guided ventriculoperitoneal shunting offering a potentially more reliable option. Objective: To prospectively compare the clinical and surgical outcomes of image-guided ventriculoperitoneal shunt insertion versus standard lumboperitoneal shunt revision in patients with failed lumboperitoneal shunts due to idiopathic intracranial hypertension. The study sought to evaluate differences in symptom improvement, visual outcomes, shunt-related complications, and mechanical failure rates between both surgical strategies. Ultimately, this work aimed to determine the more reliable and durable cerebrospinal fluid diversion procedure in this patient population. Methods: This prospective randomized controlled study was conducted at the Department of Neurosurgery, Kasr Al-Ainy School of Medicine, Cairo University, over 2 years starting in February 2024. It included 42 patients with idiopathic intracranial hypertension and failed previous lumboperitoneal shunts, confirmed clinically and/or radiologically. Patients were randomized equally into two groups: 21 underwent image-guided ventriculoperitoneal shunt insertion and 21 underwent standard lumboperitoneal shunt revision. Results: Image-guided ventriculoperitoneal shunting showed better numerical outcomes than lumboperitoneal shunt revision, with higher symptom improvement (85.71% vs. 66.67%) and lower shunt obstruction (4.76% vs. 28.57%) and visual deterioration (4.76% vs. 33.33%); however, these differences were not statistically significant. Conclusion: Image-guided ventriculoperitoneal shunting may provide more reliable clinical improvement and lower mechanical failure than standard lumboperitoneal shunt revision in patients with failed lumboperitoneal shunts due to idiopathic intracranial hypertension.
