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Treatment of Secondary Tonsillar Herniation by Lumboperitoneal Shunt Revision

Published online by Cambridge University Press:  02 December 2014

Fred C. Lam ,
Matthew B. Wheatley  and
Vivek Mehta
Fred C. Lam
Affiliation:
Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
Matthew B. Wheatley
Affiliation:
Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
Vivek Mehta
Affiliation:
Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
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Abstract

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Background:

Idiopathic intracranial hypertension (IIH) is a condition that usually affects young, obese women. Management is aimed at controlling symptoms of increased intracranial pressure (ICP) and prevention of visual failure due to papilledema. A common surgical treatment for IIH is the insertion of a lumboperitoneal shunt (LP shunt). Secondary symptomatic tonsillar herniation is an uncommon side effect following lumbar cerebrospinal fluid diversion.

Methods:

We present two cases of symptomatic secondary tonsillar herniation, one associated with a syrinx, in patients with IIH following valved LP shunting. Treatment options for this side effect may include transplanting the shunt to the ventricular system or decompression of the foramen magnum.

Results:

In our cases we elected to alter the construct of the LP shunt by inserting a programmable valve which led to clinical and radiological reversal of the tonsillar herniation as well as a dramatic reduction in an associated syrinx.

Conclusions:

When faced with LP shunt induced symptomatic secondary tonsillar herniation, consideration may be given to altering LP shunt dynamics, prior to inserting a ventricular catheter into normal sized ventricles or decompressing the posterior fossa.

Résumé:

RÉSUMÉ:

.

Contexte:

L'hypertension intracrânienne idiopathique (HII) est une maladie qui atteint habituellement de jeunes femmes obèses. Le traitement vise à contrôler les symptômes dus à l'augmentation de la pression intracrânienne (PIC) et à prévenir l'atteinte visuelle due à l'?dème papillaire. Le traitement chirurgical courant de l'HII est la mise en place d'une dérivation lombo-péritonéale (DLP). La hernie amygdalienne secondaire symptomatique est un effet secondaire rare de cette intervention.

Méthodes :

Nous décrivons deux cas de hernie amygdalienne secondaire symptomatique, dont une associée à un syrinx, chez des patientes atteintes d'HII après la mise en place d'une dérivation LP avec valve. La transplantation de la dérivation au système ventriculaire ou la décompression du trou occipital constituent le traitement de cet effet secondaire.

Résultats :

Nous avons choisi de modifier la dérivation LP en insérant une valve programmable, ce qui a fait rétrocéder la hernie amygdalienne tant au point de vue clinique que radiologique et qui a entraî#x00E9; une diminution dramatique du syrinx qui y était associé.

Conclusions :

Quand il existe une hernie amygdalienne secondaire symptomatique, on peut envisager d'abord une modification de la dynamique de la dérivation LP avant d'avoir recours à la mise en place d'un cathéter ventriculaire dans un ventricule de taille normale ou à la décompression de la fosse cérébrale postérieure.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 2 , May 2007 , pp. 237 - 242
Copyright
Copyright © The Canadian Journal of Neurological 2007

References

1. Quincke, H. Uber meningitis serosa: Sammlung linische Vortra 67. Inn Med. 1893; 23:655-94.Google Scholar
2. Durcan, FJ, Corbett, JJ, Wall, M. The incidence of pseudotumour cerebri: population studies in Iowa and Louisiana. Arch Neurol. 1988; 45:875-7.Google Scholar
3. Dandy, WE. Intracranial pressure without brain tumour: diagnosis and treatment. Ann Surg. 1937; 106:492-513.CrossRefGoogle ScholarPubMed
4. Corbett, JJ, Thompson, HS. The rational management of idiopathic intracranial hypertension. Arch Neurol. 1989; 46:1049-51.Google Scholar
5. Friedman, DI, Jacobson, DM. Idiopathic intracranial hypertension. J Neuro-Ophthalmol. 2004; 24:138-45.CrossRefGoogle ScholarPubMed
6. Newborg, B. Pseudotumour cerebri treated by rice/reduction diet. Arch Intern Med. 1974; 133:802-7.Google Scholar
7. Binder, DK, Horton, JC, Lawton, MT, McDermott, MW. Idiopathic intracranial hypertension. Neurosurgery. 2004; 54:538-52.CrossRefGoogle ScholarPubMed
8. Physician’s Desk Reference, 56th ed. Montvale, NJ: Medical Economics Company, Inc; 2002: 2590-5.Google Scholar
9. Lui, GT, Glaser, JS, Schatz, NJ. High-dose methylprednisolone and acetazolamide for visual loss in pseudotumour cerebri. Am J Ophthalmol. 1994; 118:88-96.Google Scholar
10. King, JO, Mitchell, PJ, Thomson, KR, Tress, BM. Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology. 2002; 58:26-30.CrossRefGoogle ScholarPubMed
11. Carter, S, Seiff, SR. Macular changes in pseudotumour cerebri before and after optic nerve sheath fenestration. Ophthalmology. 1995; 102:937-41.Google Scholar
12. Keltner, JL. Optic nerve sheath decompression. How does it work? Has its time come? Arch Ophthalmol. 1988; 106:1365-9.Google Scholar
13. Rosenberg, ML, Corbett, JJ, Smith, C, Goodwin, J, Sergott, R, Savino, P, et al. Cerebrospinal fluid diversion procedures in pseudotumour cerebri. Neurology. 1993; 43:1071-2.Google Scholar
14. Alleyne, CH Jr, Shutter, LA, Colohan, AR. Cranial migration of a lumboperitoneal shunt catheter. So Med J. 1996; 89:634-6.CrossRefGoogle ScholarPubMed
15. Eggenberger, ER, Miller, NR, Vitale, S. Lumboperitoneal shunt for the treatment of pseudotumour cerebri. Neurology. 1996; 46:1524-30.Google Scholar
16. Chumas, PD, Armstrong, DC, Drake, JM, Kulkarni, AV, Hoffman, HJ, Humphreys, RP, et al. Tonsillar herniaton: the rule rather than the exception after lumboperitoneal shunting in the pediatric population. J Neurosurg. 1993; 78:568-73.CrossRefGoogle Scholar
17. Johnston, I, Jacobson, E, Besser, M. The acquired Chiari malformation and syringomyelia following spinal CSF drainage. Acta Neurochir. 1998; 140:417-28.Google Scholar
18. Horton, JC, Fishman, RA. Neurovisual findings in the syndrome of spontaneous intracranial hypotension from dural cerebrospinal fluid leak. Ophthalmology. 1994; 101:244-51.Google Scholar
19. Mokri, B. Spontaneous cerebrospinal fluid leaks: from intracranial hypotension to cerebrospinal fluid hypovolemia - evolution of a concept. Mayo Clinic Proc. 1999; 74:1113-23.CrossRefGoogle ScholarPubMed
20. Pannullo, SC, Reich, JB, Krol, G, Deck, MD, Posner, JB. MRI changes in intracranial hypotension. Neurology. 1993; 43:919-26.CrossRefGoogle ScholarPubMed
21. Black, PM, Hakim, R, Bailey, N. The use of the Codman-Medos programmable Hakim valve in the management of patients with hydrocephalus: illustrative cases. Neurosurgery. 1994; 34:1110-2.Google ScholarPubMed
22. Zemack, O, Romner, B. Do adjustable shunt valves pressure our budget? A retrospective analysis of 541 implanted Codman Hakim programmable valves. Brit J Neurosurg. 2001; 15: 221-7.Google Scholar
23. Mangano, FT, Menendez, JA, Habrock, T, Narayan, P, Leonard, JR, Park, TS, et al. Early programmable valve malfunctions in pediatric hydrocephalus. J Neurosurg (6 Suppl Pediatr). 2005; 103:501-7.Google Scholar
24. Payner, TD, Prenger, E, Berger, TS, Crone, KR. Acquired Chiari malformations: incidence, diagnosis, and management. Neurosurgery. 1994; 34:429-34.Google Scholar
25. Sullivan, LP, Stears, JC, Ringel, SP. Resolution of syringomyelia and Chiari I malformation by ventriculoatrial shunting in a patient with pseudotumour cerebri and a lumboperitoneal shunt. Neurosurgery. 1988; 22:744-7.CrossRefGoogle Scholar
26. Welch, K, Shillito, J, Strand, R, Fischer, EG, Winston, KR. Chiari I “malformation” - an acquired disorder? J Neurosurg. 1981; 55:604-9.CrossRefGoogle Scholar
27. Hart, A, David, K, Powell, M. The treatment of ‘acquired tonsillar herniation’ in pseudotumor cerebri. Br J Neurosurg 2000; 14: 563-65.Google Scholar
28. Hoffman, HJ, Tucker, WS. Cephalocranial disproportion: a complication of the treatment of hydrocephalus in children. Childs Brain. 1976; 2:167-76.Google Scholar
29. Levine, DN. The pathogenesis of syringomyelia associated with lesions at the foramen magnum: a critical review of existing theories and proposal of a new hypothesis. J Neurol Sci. 2004; 220:3-21.Google Scholar
30. Willams, B. The distending force in the production of ‘communicating syringomyelia’. Lancet. 1969; 4:189-93.Google Scholar
31. Chumas, PD, Kulkarni, AV, Drake, JM, Hoffman, HJ, Humphreys, RP, Rutka, JT. Lumboperitoneal shunting: a retrospective study in the paediatric population. Neurosurgery. 1993; 32:376-83.Google Scholar
32. Fischer, EG, Welch, K, Shilito, J. Syringomyelia following lumboureteral shunting. J Neurosurg. 1977; 47:96-100.Google Scholar
33. Padmanabhan, R, Crompton, D, Burn, D, Birchall, D. Acquired Chiari I malformation and syringomyelia following lumboperitoneal shunting for pseudotumour cerebri. J Neurol Neurosurg Psych. 2005; 76:298.CrossRefGoogle ScholarPubMed