{"id":"603c7093-2610-4920-8423-582157226241","slug":"over-drainage-and-persistent-shunt-dependency-in-patients-with-idiopathic-intracranial-hypertension-treated-with-shunts-and-bariatric-surgery","title":"Over-drainage and persistent shunt-dependency in patients with idiopathic intracranial hypertension treated with shunts and bariatric surgery","authors":["Jonathan Roth","Shlomi Constantini","Anat Kesler"],"abstract":"Background: Idiopathic intracranial hypertension (IIH) may lead to visual impairment. Shunt surgery is indicated for refractory IIH-related symptoms that persist despite medical treatment, or those presenting with significant visual decline. Obesity is a risk factor for IIH; a reduction in weight has been shown to improve papilledema. Bariatric surgery (BS) has been suggested for treating IIH associated with morbid obesity. In this study, we describe a high rate of over-drainage (OD) seen in patients following shunts and BS. Methods: The study cohort includes 13 patients with IIH that underwent shunt surgery for treatment of the IIH-related symptoms. Six patients underwent BS in addition to the shunt surgery (but not concomitantly). Seven patients had only shunt surgeries with no BS. Data were collected retrospectively. Results: BS effectively led to weight reduction (body mass index decreasing from 43 ± 4 to 28 ± 5). Patients undergoing BS had 1–6 (2.5 ± 1.9) shunt revisions for OD following BS, as opposed to 0–3 (1.4 ± 1.1) revisions prior to BS over similar time spans (statistically insignificant difference), and 0–6 (1.6 ± 2.5) revisions among the non-BS patients over a longer time span (statistically insignificant difference). Two patients in the BS group underwent shunt externalization and closure; however, they proved to be shunt-dependent. Conclusions: Patients with IIH that undergo shunt surgery and BS (not concomitantly) may suffer from OD symptoms, necessitating multiple shunt revisions, and valve upgrades. Despite BS being a valid primary treatment for some patients with IIH, among shunted patients, BS may not lead to resolution of IIH-related symptoms and patients may remain shunt-dependent.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/603c7093-2610-4920-8423-582157226241/featured/hero-1782420953961.png","publishDate":"2015-12-08T00:00:00.000Z","doi":"10.4103/2152-7806.171230","categories":["Pediatric Neurosurgery","Original Article"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2015/12/6400/SNI-6-655.pdf"}