Pseudotumor cerebri patients with shunts from the cisterna magna: clinical course and telemetric intracranial pressure data.
OBJECTIVE
Shunting of cerebrospinal fluid (CSF) to an extracranial site is the mainstay of treatment of absorptive hydrocephalus and pseudotumor cerebri. On occasion, both lateral ventricles and the lumbar space become unsuitable for placement of a functioning CSF drainage catheter. We have encountered several such patients and describe our strategy of shunting from the cisterna magna to the pleural space or cardiac atrium.


METHODS
We report a retrospective review of the clinical course of five patients with cisternal shunts and intracranial pressure telemonitoring devices.


RESULTS
Cisternal shunting was able to successfully drain CSF to a normal pressure in all five patients. CSF pressure data collected from those patients indicate that the CSF pressure dynamics in cisternal shunts is similar to that of ventricular shunts. However, the cisternal shunting and subsequent high revision rate did result in a significant number of complications and two shunt infections.


CONCLUSIONS
Shunting CSF from the cisterna magna in the absence of another suitable drainage site does result in acceptable reduction of elevated intracranial pressure. However, the technique is associated with a high complication rate that may reflect the population of patients in whom this technique is required.
Lee
Max C
MC
Section of Neurosurgery, Department of Surgery, University of Chicago Hospitals and Pritzker School of Medicine, Chicago, Illinois, USA.
Yamini
Bakhtiar
B
Frim
David M
DM
D000328:Adult; D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D002946:Cisterna Magna / Q000601:surgery*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D018670:Monitoring, Ambulatory / Q000295:instrumentation* / Q000379:methods*; D011559:Pseudotumor Cerebri / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D013686:Telemetry / Q000379:methods*