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Cerebrospinal fluid diversion procedures in pseudotumor cerebri

Departments of Neurology and Surgery (Dr. Rosenberg), Uniformed Services University of the Health Sciences, Bethesda, MD; the Department of Neurology (Dr. Corbett), University of Mississippi, Jackson, MI; the Department of Medicine (Neurology) (Dr. Smith), University of Washington, Seattle, WA; the Department of Neurology (Dr. Goodwin), University of Illinois, Chicago, IL; the Departments of Ophthalmology and Neurology (Drs. Sergott and Savino), Wills Eye Hospital, Philadelphia, PA; and the Department of Neurology (Dr. Schatz), University of Miami, Miami, FL.

We reviewed the efficacy of CSF diversion for pseudotumor cerebri (PTC) in patients from six different institutions. Thirty-seven patients underwent a total of 73 lumboperitoneal shunts and nine ventricular shunts. Only 14 patients remained "cured" after a single surgical procedure. The average time between shunt insertion and shunt replacement was 9 months, although 64% of shunts lasted less than 6 months. Shunt failure (55%) and low-pressure headaches (21%) were the most common causes for reoperation. The vision of most patients improved (13) or stabilized (13) postoperatively. However, three who had initially improved subsequently lost vision. Six had a postoperative decrease in vision. Two patients improved in one eye but worsened postoperatively in the other. Four lost vision despite apparently adequate shunt function. Shunt failure with relapse of PTC occurred as late as 7 years after insertion. CSF diversion procedures have a significant failure rate as well as a high frequency of side effects.

Address correspondence and reprint requests to Dr. Michael L. Rosenberg, Department of Neurology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799.

Received August 5, 1991. Accepted for publication in final form October 16, 1992.

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