gms | German Medical Science

Objective: Data on long-term clinical outcome of pseudotumor cerebri patients receiving cerebrospinal fluid shunt therapy are sparse, especially with regard to ventricular shunt systems. We therefore aimed at evaluating the long-term clinical efficacy of different CSF diversion procedures.

Method: A retrospective chart review was conducted on patients treated between 1990 and 2015. Clinical outcome measures included the extent of visual field deficit, papilledema, optic nerve atrophy and headache, which were each scored according to the degree of impairment (1-3). For visual acuity, the arithmetic mean of both eyes was calculated, and pre-treatment values compared to long-term treatment results (Wilcoxon-Signed-Rank-Test). Other symptoms (double vision, dizziness, nausea) were considered in addition.

Results: 38 patients [4 male, mean age 37.2 yrs (± 14.3), BMI mean 35.5 (± 8.3), mean follow-up 6.4 yrs (± 6)] received 9 lumboperitoneal, 11 ventriculoatrial and 18 ventriculoperitoneal shunts. 25 patients required at least one shunt revision (mean 2 ± 3). The mean pre-treatment lumbar CSF opening pressure was 37.4 cmH₂O (± 8.1). The mean time interval between symptom-onset and shunt placement was 13.2 months (± 19.3). Preoperatively, headache was present in 97%, papilledema in 92%, optic nerve atrophy in 3%, visual field deficits in 91% and other symptoms in 57%. Long-term follow-up in patients with shunts showed papilledema in 9%, optic nerve atrophy in 26%, visual field deficits in 65%, other symptoms in 30% and headache in 59% of the patients. While pre- and post-treatment visual acuity and visual field deficits did not differ significantly, headache (p<0.0001), papilledema (p<0.0001) and other symptoms improved significantly (p<0.006). However, a significant number of patients developed optic nerve atrophy (p<0.01) despite treatment. Apart from other symptoms (p<0.011), neither clinical outcome measures nor epidemiological data differed significantly between patients with different shunt types. Increased incidence of revision correlated with optic nerve atrophy (p<0.027).

Conclusions: Different CSF diversion procedures were equally effective in the long-term treatment of pseudotumor cerebri. However, optic nerve atrophy occurred despite therapy, thus limiting functional recovery. Prospective data with larger patient series are required to clarify, whether this might be due to treatment failure or due to irreversible damage preceding shunt placement.