The effects of lumboperitoneal and ventriculoperitoneal shunts on the cranial and spinal cerebrospinal fluid volume in a patient with idiopathic intracranial hypertension

Nikić, Ines and Radoš, Milan and Frobe, Ana and Vukić, Miroslav and Orešković, Darko and Klarica, Marijan (2016) The effects of lumboperitoneal and ventriculoperitoneal shunts on the cranial and spinal cerebrospinal fluid volume in a patient with idiopathic intracranial hypertension. Croatian Medical Journal, 57 (3). pp. 293-297. ISSN 0353-9504

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Abstract

Lumboperitoneal (LP) and ventriculoperitoneal (VP) shunts are a frequent treatment modality for idiopathic intracranial hypertension (IIH). Although these shunts have been used for a long time, it is still not clear how they change the total craniospinal CSF volume and what portions of cranial and spinal CSF are affected. This report for the first time presents the results of a volumetric analysis of the total cranial and spinal CSF space in a patient with IIH. We performed an automated segmentation of the cranial and a manual segmentation of the spinal CSF space first with an LP shunt installed and again after the LP shunt was replaced by a VP shunt. When the LP shunt was in place, the total CSF volume was smaller than when the VP shunt was in place (222.4 cm(3) vs 279.2 cm(3)). The difference was almost completely the result of the spinal CSF volume reduction (49.3 cm(3) and 104.9 cm(3) for LP and VP, respectively), while the cranial CSF volume was not considerably altered (173.2 cm(3) and 174.2 cm(3) for LP and VP, respectively). This report indicates that LP and VP shunts in IIH do not considerably change the cranial CSF volume, while the reduction of CSF volume after LP shunt placement affects almost exclusively the spinal part of the CSF system. Our results suggest that an analysis of both the cranial and the spinal part of the CSF space is necessary for therapeutic procedures planning and for an early recognition of numerous side effects that often arise after shunts placement in IIH patients.

Abstract in Croatian

Učinci lumboperitonealnih i ventrikuloperitonealih šantova na kranijalni i spinalni volumen cerebrospinalnog likvora kod pacijenta s idiopatskom intrakranijalnom hipertenzijom ----- Ugradnja lumboperitonealnih (LP) i ventrikuloperitonealnih (VP) šantova učestali je način liječenja idiopatske intrakranijalne hipertenzije (IIH). Iako su ovi šantovi već dugo u uporabi, još nije poznat njihov utjecaj na ukupan kraniospinalni volumen cerebrospinalnog likvora (prema engl. cerebrospinal fluid, CSF) te na volumen kranijalne i spinalne CSF zasebno. Ovaj članak po prvi put predstavlja rezultate volumetrijske analize ukupnog kranijalnog i spinalnog CSF prostora kod pacijenta s IIH. Napravili smo automatsku segmentaciju kranijalnog i manualnu segmentaciju spinalnog CSF prostora, prvi put dok je pacijent imao ugrađen LP šant te ponovno nakon što je LP šant zamijenjen VP šantom. Dok je pacijent imao ugrađen LP šant, ukupni CSF volumen bio je manji nego nakon ugradnje VP šanta (222,4 cm3 nasuprot 279,2 cm3). Razlika se gotovo u potpunosti može pripisati smanjenju spinalnog CSF volumena (49,3 cm3 za LP i 104,9 cm3 za VP), dok se kranijalni CSF volumen nije bitno promijenio (173,2 cm3 za LP i 174,.2 cm3 za VP). Ovaj članak pokazuje da LP i VP šantovi bitno ne mijenjaju kranijalni CSF volumen kod IIH, dok smanjenje CSF volumena nakon ugradnje LP šanta gotovo isključivo utječe na spinalni dio CSF sustava. Naši rezultati pokazuju da je za planiranje liječenja i rano otkrivanje brojnih neželjenih učinaka koji se često pojavljuju nakon ugradnje šantova kod pacijenata s IIH nužna analiza kako kranijalnog, tako i spinalnog dijela CSF prostora.

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