Management of idiopathic intracranial hypertension with a programmable lumboperitoneal shunt: Early experience

•LP shunt with a programmable Strata valve system is a new modality in the management of IIH.•It allows flexible post-operative valve pressure adjustment; thus, avoiding the development of over- or underdrainage symptoms.•All patients reported resolution of their symptoms and improvement in their visual functions.•No intra- or post-operative complications were encountered in the cohort.•This modality is considered a safe and effective potential alternative to VP shunt and ONSF in managing IIH patients.

ObjectiveTo evaluate the clinical outcomes and complications rate among idiopathic intracranial hypertension (IIH) patients who underwent lumboperitoneal (LP) shunt insertion with a programmable Strata valve.MethodsWe retrospectively evaluated patients who underwent LP shunt with a programmable Strata valve insertion at the University of Ottawa Civic Hospital from November 2012 to June 2013. The demographic data, clinical symptoms, opening pressure, pre-operative and post-operative visual fields, neuroimaging, visual acuity, disc status, and complications were recorded and analyzed.ResultsSeven female patients with IIH underwent insertion of an LP shunt with a programmable Strata valve. The mean opening pressure was 35.8 cm H2O. The initial valve setting was 1.5, and four patients required post-operative valve pressure adjustment. All patients showed significant improvement in objective visual testing at follow-up as well as less frequent headaches. None of the patients developed intra- or post-operative complications.ConclusionLP shunts with programmable Strata valve systems are a potential alternative to conventional LP and programmable ventriculoperitoneal shunt systems as well as optic nerve sheath fenestration, due to their potential in avoiding brain injury, lower failure and complication rates, lower intracranial hypotension incidence, and flexibility in adjusting valve pressure settings post-operatively evading under- and overdrainage complications. They should be considered for the management of IIH instead of early design LP systems and VP shunts. A randomized multi-center trial should be conducted to compare the efficacy of these surgical techniques.