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Shunt Revision and Complications in Idiopathic Intracranial Hypertension Treatment: A Comparative Analysis of Lumboperitoneal and Ventriculoperitoneal Shunts

Friday, May 3, 2024

    Presenting Author(s)

  • Filipi Andreão

    Medical Student
    Federal University of Rio de Janeiro
    Rio de Janeiro, RJ, BR

    • Co-Author(s)

  • DA

    Diego Gomez Amarillo, n/a

    Neurosurgeon
    Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia, United States

  • SB

    Savio Batista, n/a

    Medical student
    Federal University of Rio de Janeiro, United States

  • Raphael Bertani, MD

    Neurosurgeon
    Department of Neurosurgery, University of São Paulo
    São Paulo, SP, BR

  • Marcio Yuri Ferreira, MD

    Research Collaborator
    Program in Global Surgery and Social Change - Harvard Medical School. Postgraduate Program in Translational Surgery of Federal University of São Paulo, Brazil

  • FH

    Fernando Hakim, n/a

    Neurosurgeon
    Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia, Colombia

  • FJ

    Flavio Júnyor, n/a

    Medical Student
    Federal University of Rio de Janeiro
    Rio de Janeiro, Rio de Janeiro, Brazil

  • Leonardo de Barros Oliveira (he/him/his)

    Medical Student
    Department of Neurosurgery, State University of Ponta Grossa, Paraná, Brazil

  • Lucca B. Palavani

    Medical Student
    Max Planck University Center

  • MARCELO Porto Sousa (he/him/his)

    Medical Student
    Federal University of Rio de Janeiro

  • LR

    Luis Rairan, n/a

    Medical Student
    Universidad El Bosque
    Bogotá, Colombia

  • IT

    Isadora Tinti, n/a

    Medical Student
    Federal University of Rio de Janeiro
    Rio de Janeiro, Rio de Janeiro, Brazil

Introduction: Idiopathic Intracranial Hypertension (IIH) is a complex condition with elevated intracranial pressure in obese women of childbearing age, often without structural issues. It involves factors like excessive cerebrospinal fluid (CSF) production and outflow obstruction. Initial treatments focus on weight management and CSF reduction, but severe cases may require surgery. This study analyzes postoperative outcomes in IIH patients treated with lumboperitoneal shunts (LPS) versus ventriculoperitoneal shunts (VPS).

Methods: This systematic-review and meta-analysis follows PRISMA guidelines and includes studies on VPS and LPS patients, reporting shunt revision, complications, failure, and infection rates in English. We conducted searches on PubMed, Embase, Web of Science, and Cochrane Library.

Results: The analysis of shunt revision status involved six studies, comprising 3394 VPS and VPS and 2215 LPS cases, revealed an OR of 1.53 (95% CI 0.97 to 2.41; I²=77%). Analysis of shunt complications included six studies, involving 3394 VPS and 2215 LPS cases, showed an OR of 0.91 (95% CI 0.68 to 1.22; I²=0%). A sub analysis for shunt failure, involving four studies and a total of 877 VPS and 435 LPS cases, uncovered an OR of 1.41 (95% CI 0.92 to 2.18; I²=25%). Finally, a sub analysis for shunt infection events included four studies, comprising 880 VPS and 436 LPS cases. The estimated OR for shunt infection was 0.94 (95% CI 0.50 to 1.75; I²=0%).

Conclusion : This analysis provides important insights into surgical management of IIH, comparing LPS and VPS procedures. No significant differences were found in shunt revision and complication rates. Subanalysis of the risk of shunt infections and shunt failure between the two procedures also did not reveal statistical significance. Further research, larger sample sizes, and prospective investigations are essential for a conclusive assessment of their comparative outcomes.