IH Registry Study Finds Type of Initial Surgery to Treat IH Affects Number of Future Procedures
January 1, 2006—A recent study suggests a correlation between the choice of the primary surgical procedure and the need for subsequent surgeries in IH patients with vision loss due to intracranial pressure. The study was conducted by Susan C. Benes, M.D., from Ohio State University in Columbus OH and run in conjunction with the IH Registry.
Data from a group of 297 patients in the IH Registry was examined. Slightly more than half (166 or 56%) of the patients were medically managed and did not require surgery. But 131 (44%) required surgery; 67 patients had a cerebrospinal fluid shunt (CSFS) as their first procedure, while 58 had optic nerve sheath decompressions (ONSD) initially. All patients who had surgery were followed for more than a year.
In the CSFS group, Dr. Benes found that 52 patients (78%) needed further operations. The combined total of operations for this sub-group was 192, with an average of 3.7 surgeries per patient. In the ONSD group, only 17 patients (29%) needed further surgery. The combined total of operations for this sub-group was 49, with an average of 2.9 per patient. The lowest re-operation rate was observed in the group that had bilateral simultaneous—i.e. both eyes are operated on during the procedure—optic nerve sheath decompression surgery as their first procedure. Only two of 32, or 6%, had further surgery. But Dr. Benes reported that because this group only had 32 patients, this particular discovery needs further study to confirm the trend.
The lower re-operation rate is considered statistically significant. Dr. Benes concluded that among patients in this study who required additional surgery, those who had an ONSD as their initial procedure required fewer procedures (3.4+/-8.0) than those who initially underwent CSFS (5.7+/-15.7). She suggested additional study of the order of CSF diversion surgeries.