Factors Associated with Subsequent Lumboperitoneal Shunt Requirement in Adult Women with Idiopathic Intracranial Hypertension: A Prospective Cohort Study
4 affiliations
- 1Associate Professor of Neurosurgery department, Faculty of Medicine, Zagazig University, Egypt
- 2Professor of Neurosurgery department, Faculty of Medicine, Zagazig University, Egypt
- 3Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
- 4Lecturer of Neurosurgery department, Faculty of Medicine, Zagazig University, Egypt
Abstract
Background: Cerebrospinal fluid (CSF) diversion may be required in idiopathic intracranial hypertension (IIH) when medical therapy fails or vision deteriorates. Early identification of patients likely to require shunting may facilitate timely neurosurgical referral. This study aimed to identify baseline factors associated with lumboperitoneal (LP) shunt requirement in adults with IIH.
Methods: This prospective observational cohort study included 40 female patients aged 18–50 years. All initially received conservative medical therapy and were followed for three months. Twenty patients required LP shunting, while 20 were successfully managed conservatively. Baseline clinical, ophthalmological, radiological, and CSF opening-pressure parameters were compared, and binary regression analysis identified factors associated with shunting.
Results: Patients requiring LP shunting had significantly higher BMI (33.01±3.30 vs. 27.10±2.86 kg/m²; P<0.001) and CSF opening pressure (32.85±7.23 vs. 18.20±4.06 cmH₂O; P<0.001). High-grade papilledema (57.5% vs. 10%; P<0.001) and venous sinus stenosis (50% vs. 10%; P=0.006) were more frequent in the shunt group. In multivariable analysis, BMI (AOR=1.730; P=0.041) and opening pressure (AOR=1.363; P=0.019) were significant. In backward analysis, opening pressure remained independently significant (AOR=1.391; P=0.009), while BMI was borderline (P=0.052). Headache improved significantly in both groups, with no difference in percentage improvement (P=0.409).
Conclusion: Elevated CSF opening pressure was the strongest independent predictor of LP shunt requirement. Higher BMI, severe papilledema, and venous sinus stenosis may also help identify patients at risk of conservative treatment failure
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BibTeX
@article{ali2026factors,
title = {{Factors Associated with Subsequent Lumboperitoneal Shunt Requirement in Adult Women with Idiopathic Intracranial Hypertension: A Prospective Cohort Study}},
author = {Ahmed Morsy Ali and Mahmoud Taha and Abdalah Ramadan Elashry and Mustafa Mustafa El-Zoheiry},
journal = {Zagazig University Medical Journal},
year = {2026},
month = oct,
doi = {10.21608/zumj.2026.526366.4804},
url = {https://doi.org/10.21608/zumj.2026.526366.4804},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Factors Associated with Subsequent Lumboperitoneal Shunt Requirement in Adult Women with Idiopathic Intracranial Hypertension: A Prospective Cohort Study
AU - Ahmed Morsy Ali
AU - Mahmoud Taha
AU - Abdalah Ramadan Elashry
AU - Mustafa Mustafa El-Zoheiry
PY - 2026
DA - 2026/10/25
JO - Zagazig University Medical Journal
DO - 10.21608/zumj.2026.526366.4804
UR - https://doi.org/10.21608/zumj.2026.526366.4804
AB - Background: Cerebrospinal fluid (CSF) diversion may be required in idiopathic intracranial hypertension (IIH) when medical therapy fails or vision deteriorates. Early identification of patients likely to require shunting may facilitate timely neurosurgical referral. This study aimed to identify baseline factors associated with lumboperitoneal (LP) shunt requirement in adults with IIH. Methods: This prospective observational cohort study included 40 female patients aged 18–50 years. All initially received conservative medical therapy and were followed for three months. Twenty patients required LP shunting, while 20 were successfully managed conservatively. Baseline clinical, ophthalmological, radiological, and CSF opening-pressure parameters were compared, and binary regression analysis identified factors associated with shunting. Results: Patients requiring LP shunting had significantly higher BMI (33.01±3.30 vs. 27.10±2.86 kg/m²; P<0.001) and CSF opening pressure (32.85±7.23 vs. 18.20±4.06 cmH₂O; P<0.001). High-grade papilledema (57.5% vs. 10%; P<0.001) and venous sinus stenosis (50% vs. 10%; P=0.006) were more frequent in the shunt group. In multivariable analysis, BMI (AOR=1.730; P=0.041) and opening pressure (AOR=1.363; P=0.019) were significant. In backward analysis, opening pressure remained independently significant (AOR=1.391; P=0.009), while BMI was borderline (P=0.052). Headache improved significantly in both groups, with no difference in percentage improvement (P=0.409). Conclusion: Elevated CSF opening pressure was the strongest independent predictor of LP shunt requirement. Higher BMI, severe papilledema, and venous sinus stenosis may also help identify patients at risk of conservative treatment failure
SN - 2357-0717
SN - 1110-1431
ER -