title: Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review.
abstract: BACKGROUND
  The role of cerebrospinal fluid (CSF) diversion in treating idiopathic intracranial hypertension (IIH) is disputed.
  
  
  METHODS
  We conducted a 10-year, retrospective case note review to evaluate the effects of CSF diversion in IIH. Symptoms, signs and details of shunt type, complications and revisions were documented at baseline, 6, 12 and 24 months post-operatively.
  
  
  RESULTS
  Fifty-three IIH patients were shunted [predominantly lumboperitoneal (92%)]. The most common symptom pre-surgery was headache (96%). Post-operatively, significantly fewer patients experienced declining vision and visual acuity improved at 6 (p = 0.001) and 12 months (p = 0.016). Headache continued in 68% at 6 months, 77% at 12 months and 79% at 2 years post-operatively. Additionally, post-operative low-pressure headache occurred in 28%. Shunt revision occurred in 51% of patients, with 30% requiring multiple revisions.
  
  
  CONCLUSIONS
  We conclude that CSF diversion reduces visual decline and improves visual acuity. Unfortunately, headache remained in the majority of patients and low-pressure headache frequently complicated surgery. Over half of the patients required shunt revision with the majority of these requiring multiple revisions. We suggest that CSF shunting should be conducted as a last resort in those with otherwise untreatable, rapidly declining vision. Alternative treatments, such as weight reduction, may be more effective with less associated morbidity.
authors.affiliation: University of Birmingham, UK. a.b.sinclair@bham.ac.uk
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Sinclair
authors.forename: Sarin
authors.initials: S
authors.lastname: Kuruvath
authors.forename: Diptasri
authors.initials: D
authors.lastname: Sen
authors.forename: Peter G
authors.initials: PG
authors.lastname: Nightingale
authors.forename: Michael A
authors.initials: MA
authors.lastname: Burdon
authors.forename: Graham
authors.initials: G
authors.lastname: Flint
mesh_terms: D000328:Adult; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011559:Pseudotumor Cerebri / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies