• Ian White, Megan Tuohy, Michael Turner, and Albert Lee.
• Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana.
• Neurosurgery. 2021 Jan 13; 88 (2): 306-312.

BackgroundShunting procedures have a high failure rate when used to treat pseudotumor cerebri (PTC) patients who have failed medical therapy. This failure is believed to be attributable to the collapsibility of the ventricular system when exposed to increased differential pressure gradients in the cerebral spinal fluid compartments caused by ventriculoperitoneal shunts (VPS).ObjectiveTo investigate whether prepontine/interpeduncular cistern shunting may be a reasonable alternative to VPS intervention in PTC patients with history of shunt failure. There have been no large series of cisternal-peritoneal shunt (CPS) patients in the PTC population.MethodsA retrospective review of 49 patients with placement of CPS for PTC with 2 failed prior shunting procedures was performed. Shunt survivability was based on shunt patency and resolution of ophthalmologic symptoms and cranial nerve deficits. All patients were followed for a minimum of 3 yr with serial ophthalmologic and neurosurgical evaluations.ResultsAt 3 yr, 44 of the 49 (88.9%) patients had working CPS. Three patients in this group had infections requiring complete shunt removal. Excluding infections, 44 of 46 (95.5%) shunts were functional at 3 yr. There were 3 small, asymptomatic hemorrhages that did not increase patient length of stay, and there were no catastrophic hemorrhages or strokes. There were also no abdominal complications related to shunt placement.ConclusionCPS is a viable alternative to VPS in PTC patients who have failed traditional shunting methods to give these patients a persistent benefit of a working shunt. The procedure provides this solution with low operative and perioperative morbidity.Copyright © 2020 by the Congress of Neurological Surgeons.

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