The Birmingham standardized idiopathic intracranial hypertension shunt protocol: technical note.
Tsermoulas, Georgios Thant, Kyaw Zayar Byrne, Marian E Whiting, John L White, Anwen M Sinclair, Alexandra J Mollan, Susan P
Tsermoulas, Georgios
Thant, Kyaw Zayar
Byrne, Marian E
Whiting, John L
White, Anwen M
Sinclair, Alexandra J
Mollan, Susan P
Abstract
Background: Insertion of cerebrospinal fluid (CSF) shunts in patients with idiopathic intracranial hypertension (IIH) is challenging mainly due to the small ventricles and phenotypical body habitus. In this report the authors present their surgical protocol for insertion of a ventriculoperitoneal shunt (VPS) in patients with IIH and the associated revision rates.
Methods: The protocol comprises the following: shunt surgery by neurosurgeons with expertise in CSF disorders; a frontal VPS usually right sided but left sided if the left ventricle is bigger; use of the proGAV 2.0 valve with gravitational unit, set at 10 and the M.scio telemetric sensor; cannulation of the ventricle with StealthStation EM navigation system; and laparoscopic insertion of the peritoneal catheter. The authors describe the protocol and rationale and evidence behind each component and present the results of a prospective analysis on revision rates.
Results: The protocol has been implemented since 1 July, 2019, and by 28 February, 2022, sixty-two patients with IIH had undergone primary VPS insertion. The 30-day revision rate was 6.5%, and overall 11.3% of patients underwent revision during the study period, which compares favorably with the literature. The etiology for early failures was related to the surgical technique.
Conclusions: The components of the Birmingham standardized IIH shunt protocol are evidence based and address the technical challenges of CSF diversion in patients with IIH. This protocol is associated with a low revision rate, and the authors recommend standardization for CSF shunting in IIH.
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Date
2022-09-09
Type
Article
Subject
Gastroenterology, Ophthalmology
Collections
Citation
Tsermoulas G, Thant KZ, Byrne ME, Whiting JL, White AM, Sinclair AJ, Mollan SP. The Birmingham Standardized Idiopathic Intracranial Hypertension Shunt Protocol: Technical Note. World Neurosurg. 2022 Nov;167:147-151. doi: 10.1016/j.wneu.2022.08.154. Epub 2022 Sep 9
Journal / Source Title
World Neurosurgery
DOI
10.1016/j.wneu.2022.08.154
PMID
36089279
Publisher
Elsevier
Publisher’s URL
http://www.sciencedirect.com/science/journal/18788750