CASE SERIES Experience With Ventriculoperitoneal and Lumboperitoneal Shunting for the Treatment of Idiopathic Intracranial Hypertension: A Single Institution Series Ahmad Sweid, MD * Badih J. Daou, MD ‡ Joshua H. Weinberg, BS * Robert M. Starke, MD § Robert C. Sergott, MD ¶ Joseph Schaefer, BChE * Julie Hauge, BS || Caroline Elizabeth, BA # Nohra Chalouhi, MD * Reid Gooch, MD * Nabeel Herial, MD * Hekmat Zarzour, MD * Pascal Jabbour, MD * Robert H. Rosenwasser, MD * Stavropoula Tjoumakaris, MD * ∗ Department of Neurosurgery, Thomas Jeferson University and Jeferson Hos- pital for Neuroscience, Philadelphia, Pen- nsylvania, USA; ‡ Department of Neur- osurgery, University of Michigan, Ann Arbor, Michigan, USA; § Department of Neurosurgery, University of Miami Hos- pital, Miami, Florida, USA; ¶ Neuro-Oph- thalmology Service, Wills Eye Hospital and Thomas Jeferson University, Phil- adelphia, Pennsylvania, USA; || University of Pennsylvania, Philadelphia, Pennsyl- vania, USA; # Amherst College, Philade- lphia, Pennsylvania, USA Correspondence: Stavropoula Tjoumakaris, MD, Neurological Surgery, Division of Neurovascular Surgery and Endovascular Neurosurgery, Thomas Jeferson University Hospital, 901 Walnut St 3rd Floor, Philadelphia, PA 19107, USA. Email: stavropoula.tjoumakaris@jeferson.edu Twitter: @TJUHNeurosurg Received, December 20, 2019. Accepted, February 8, 2021. Published Online, April 22, 2021. C  Congress of Neurological Surgeons 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com BACKGROUND: CSF shunting is among the most widely utilized interventions in patients with idiopathic intracranial hypertension (IIH). Ventriculoperitoneal shunting (VPS) and lumboperitoneal shunting (LPS) are 2 possible treatment modalities. OBJECTIVE: To evaluate and compare complications, malfunction, infection, and revision rates associated with VPS compared to LPS. METHODS: Electronic medical records were reviewed to identify baseline and treatment characteristics for patients diagnosed with IIH treated with VPS or LPS. RESULTS: A total of 163 patients treated with either VPS (74.2%) or LPS (25.8%) were identifed. The mean follow-up was 35 mo. Shunt revision was required in 40.9% of patients. There was a nonsignifcant higher rate of revision with LPS (52.4%) than VPS (36.4%, P = .07). In multivariate analysis, increasing patient age was associated with higher odds of shunt revision (P = .04). LPS had higher odds of shunt revision, yet this association was not signifcant (P = .06). Shunt malfunction was the main indication for revision occurring in 32.7%, with a signifcantly higher rate with LPS than VPS (P = .03). In total, 15 patients had shunt infection (9.4% VPS vs 12.2% LPS P = .50). The only signifcant predictor of procedural infection was the increasing number of revisions (P = .02). CONCLUSION: The incidence of shunt revision was 40.9%, with increasing patient age as the sole predictor of shunt revision. The incidence of shunt malfunction was signif- cantly higher in patients undergoing LPS, while there was no signifcant diference in the incidence of shunt infection between the 2 modalities. KEY WORDS: IIH, VPS, LPS, Shunting, Pseudotumor cerebri Operative Neurosurgery 21:57–62, 2021 https://doi.org/10.1093/ons/opab106 I diopathic Intracranial Hypertension (IIH) or Pseudotumor Cerebri is a disorder charac- terized by elevated intracranial pressure (ICP) with a normal cerebrospinal fluid (CSF) profile in the absence of another cause of increased ICP. 1 The present study analyzes the results of a large institutional experience with shunting in IIH patients with the objective of evaluating the complication, malfunction, infection, and revision rates between LPS and VPS. In addition, were analyzed possible ABBREVIATIONS: IIH, idiopathic intracranial hyper- tension; LPS, lumboperitoneal shunting; VPS, ventriculoperitoneal shunting predictors of shunt revision in patients with IIH undergoing CSF diversion procedures. METHODS Study Design This is a retrospective cohort study. The Institu- tional Review Board approved the study protocol, and patient consent was waived due to the study design. The relevant anonymized patient level data are available on reasonable request from the authors. Electronic medical records and medical charts were reviewed to identify patients diagnosed with IIH or pseudotumor cerebri using ICD-9 codes over 10 yr at a tertiary care center (2009-2019). Baseline patient characteristics and treatment regimens for patients with the diagnosis of IIH were identified. OPERATIVE NEUROSURGERY VOLUME 21 | NUMBER 2 | AUGUST 2021 | 57 Downloaded from https://academic.oup.com/ons/article/21/2/57/6245859 by guest on 14 August 2021