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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

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