title: Outcomes and Experience with Lumbopleural Shunts in the Management of Idiopathic Intracranial Hypertension.
abstract: OBJECTIVE
  To report five patients who underwent lumbopleural (LPl) shunting for the treatment of idiopathic intracranial hypertension (IIH) and to describe the considerations, complications, and outcomes related to this rarely described procedure.
  
  
  METHODS
  The clinical data of five patients treated with LPl shunting over a 23-year period were retrospectively analyzed. Factors including the age at diagnosis of IIH, age at time of LPl shunting, body mass index (BMI), reason for LPl shunt placement, number of revisions before LPl shunt placement, valve type, time to first revision, presence of overdrainage and its management, complications and their management, survival time of LPl shunt, and clinical course at last follow-up were analyzed.
  
  
  RESULTS
  All patients were morbidly obese females with an average of 4.6 shunt revisions before an LPl shunt. The average overall survival time of the LPl shunt was 48 months. Two patients experienced failure of their LPl shunts with subsequent replacement within the first year. Four patients experienced complications related to shunt overdrainage, requiring placement of an antisiphon device (ASD) or additional valve. One patient developed a symptomatic pleural effusion, and one patient developed a small pneumothorax, which was managed conservatively.
  
  
  CONCLUSIONS
  LPl shunting, though rarely used, is a viable option in the treatment of IIH refractory to standard peritoneal shunting. When pursuing this treatment, a valve and ASD are recommended to mitigate the risks of overdrainage and pleural effusion. Chest imaging should be obtained if the patient becomes symptomatic but can be deferred if the patient remains asymptomatic and is doing well.
authors: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: belder4@jhmi.edu.
authors: Benjamin D
authors: BD
authors: Elder
authors: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Eric W
authors: EW
authors: Sankey
authors: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: C Rory
authors: CR
authors: Goodwin
authors: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Ignacio
authors: I
authors: Jusué-Torres
authors: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Mohamed H
authors: MH
authors: Khattab
authors: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Daniele
authors: D
authors: Rigamonti
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D018579:Patient Selection; D011559:Pseudotumor Cerebri / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt; D055815:Young Adult
keywords: Hydrocephalus; Idiopathic intracranial hypertension; Lumbopleural shunt; Pseudotumor cerebri