gms | German Medical Science

Introduction: Surgical techniques for the treatment of pseudotumor cerebri are several. There are different opinions about the optimal solution. Advantages and disadvantages are described.

Materials and methods: Different Shunt techniques are used: e.g. the ventriculoperitoneal shunt, which is positioned laparoscopically in our clinic in cooperation with the Department of General Surgery. The patient is in the supine position, head in a head ring.

In lumboperitoneal approaches the shunt goes from spinal lumbar to the abdomen. Patient is in lateral position, this produces problems for the laparoscopic technique. Duration of surgery is about 35-45 minutes.

Results: Complication rate in shunt surgery in literature is described with 15 %. Shunt infections and shunt disconnection are most common. There are specific differences between lumboperitoneal and ventrikulperitoneal Shunt also according complications. In ventriculoperitoneal shunt positioning of ventricular catheter is difficult, because ventricular system is narrow. In this cases usage of navigation systems has to be taken into account in order to improve precision. Lumboperitoneal shunts are difficult to control in comparison to vp-shunts because there is no ventil. If shunt dysfunction has to be excluded, lumbar puncture and pressure measurement is recommended.

Conclusion: Despite of alternative treatment options like diamox, neurointerventional techniques and repeated lumbar punctures there are still indications for shunts especially in patients with progredient visual disturbances. Patients have to be instructed about the high complication rates and the possibility of revision surgery.