title: Cervical puncture and perimedullary cistern shunt placement for idiopathic intracranial hypertension: An alternative to lumbar cistern or cerebral ventricular catheter placement a report of two cases.
abstract: OBJECTIVE
  Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure (ICP) in the absence of an identifiable cause, and if untreated, can result in permanent vision loss. In symptomatic IIH patients, cerebrospinal fluid (CSF) diversion can lower ICP and protect vision; however, currently used CSF diversion systems are prone to malfunction in this population.
  
  
  METHODS
  In two IIH patients with histories of numerous prior shunt revisions that presented with proximal ventriculoperitoneal shunt malfunction, ICP reduction was achieved by an alternative surgical cerebrospinal fluid (CSF) diversion technique: Fluoroscopically guided, percutaneous placement of a catheter in the premedullary cistern and subsequent connection to the valve and distal shunt system.
  
  
  RESULTS
  Postoperatively, both patients' papilledema resolved, headaches improved, and the shunts were working well at 3-month follow-up. At 1-year follow-up, one patient was well without papilledema or symptom recurrence, and the second patient had the shunt system removed by an outside surgeon.
  
  
  CONCLUSIONS
  This technique may hold promise as an alternative shunting strategy in IIH patients with numerous proximal shunt failures or who are poor candidates for ventricular and lumbar shunts.
authors: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors: Jeremiah N
authors: JN
authors: Johnson
authors: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors: Mohamed Samy
authors: MS
authors: Elhammady
authors: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors: Christian B
authors: CB
authors: Theodotou
authors: Department of Neurosurgery, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors: Ramsey
authors: R
authors: Ashour
authors: Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
authors: Mohammad Ali
authors: MA
authors: Aziz-Sultan
keywords: Cerebrospinal fluid; cerebrospinal fluid shunts; cervical vertebrae; idiopathic intracranial hypertension; pseudotumor cerebri