title: Is there a difference in outcomes of patients with idiopathic intracranial hypertension with the choice of cerebrospinal fluid diversion site: a single centre experience.
abstract: The visual and headache outcomes in patients with idiopathic intracranial hypertension (IIH) undergoing cerebrospinal fluid diversion with a lumboperitoneal (LPS) or ventriculoperitoneal shunting (VPS) have not been well reported. The aims of this study were to: (a) to assess outcomes of CSF diversion in IIH, (b) to understand influence of the type of shunt in outcomes, and (c) to understand factors predisposing in shunt failure.
  
  
  METHODS
  The medical records of 34 patients who underwent cerebrospinal fluid diversion (CSFD) between 1996 and 2007 were retrieved and epidemiological and clinical data was collected.
  
  
  RESULTS
  The mean age was 35 (±7.9) years. Thirty-four patients underwent 63 shunt placements in total. 85% follow-up was achieved. The mean follow-up for the entire group was 28.9 (±31.8) months. Headaches improved more than visual disturbances. There was no significant difference between the groups that received a VPS and those receiving an LPS in both headache and visual outcomes. The rate of complications was 20.5% and the need for revision was 35% for the whole group. Patients with LPS suffered more complications and first time revisions than patients with VPS. No factor recorded could predict the need for revision or final outcomes. The shunts of patients receiving a VPS tend to survive longer than those receiving primarily an LPS, however the difference is not statistically significant.
  
  
  CONCLUSIONS
  Predicting which patients will improve is not possible at present. The influence of site diversion is not critical but patients with VPS have less complications and revisions than those receiving a LPS.
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC 1N 3BG, UK. andrewtarnaris@gmail.com
authors.forename: Andrew
authors.initials: A
authors.lastname: Tarnaris
authors.forename: Ahmed K
authors.initials: AK
authors.lastname: Toma
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Watkins
authors.forename: Neil D
authors.initials: ND
authors.lastname: Kitchen
mesh_terms: D000328:Adult; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006261:Headache / Q000209:etiology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011559:Pseudotumor Cerebri / Q000134:cerebrospinal fluid / Q000150:complications / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D013129:Spinal Puncture; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000379:methods; D014786:Vision Disorders / Q000209:etiology / Q000628:therapy