Electromagnetic stereotactic ventriculoperitoneal csf shunting for idiopathic intracranial hypertension: a successful step forward?

Abstract

The optimal management of medically refractory idiopathic intracranial hypertension (IIH) remains a point of debate. The senior author's practice evolved after a review of our units' practice in placing lumboperitoneal shunts revealed an unacceptably high rate of complication and revision. We now preferentially perform custom-designed electromagnetic (EM) image-guided ventriculoperitoneal shunt placement instead of lumboperitoneal shunting in treating medically refractory IIH and present our outcome data with this technique. Retrospective case note review was carried out with prospective follow-up of 17 patients treated consecutively over a 3-year period. The article aims to assess the implication of using EM image-guided tracking technology in ventricular catheter placement in patients with IIH and to assess outcome. All of the patients improved clinically at the last follow-up compared to their preoperative condition. None of the patients experienced intra- or perioperative complications. All patients underwent ventriculoperitoneal shunt placement using EM guidance navigation. All patients in the EM subgroup were cannulated with a single pass, and satisfactory catheter placement was confirmed on a postoperative CT scan with concordant patient symptom improvement. Our series suggests that EM image-guided ventriculoperitoneal cerebrospinal fluid (CSF) shunting for IIH is a safe and effective procedure for ventricular cannulation and placement.