{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T06:11:03Z","timestamp":1792649463794,"version":"4.5.0"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Complications following lumboperitoneal (LP) shunting have been reported in 18% to 85% of cases. The need for multiple revision surgeries, development of iatrogenic Chiari malformation, and frequent wound complications have prompted many to abandon this procedure altogether for the treatment of idiopathic benign intracranial hypertension (pseudotumor cerebri), in favor of ventriculoperitoneal (VP) shunting. A direct comparison of the complication rates and health care charges between first-choice LP versus VP shunting is presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Nationwide Inpatient Sample database was queried for all patients with the diagnosis of benign intracranial hypertension (International Classification of Diseases, Ninth Revision, code 348.2) from 2005 to 2009. These data were stratified by operative intervention, with demographic and hospitalization charge data generated for each.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A weighted sample of 4480 patients was identified as having the diagnosis of idiopathic intracranial hypertension (IIH), with 2505 undergoing first-time VP shunt placement and 1754 undergoing initial LP shunt placement. Revision surgery occurred in 3.9% of admissions (n = 98) for VP shunts and in 7.0% of admissions (n = 123) for LP shunts (p &lt; 0.0001). Ventriculoperitoneal shunts were placed at teaching institutions in 83.8% of cases, compared with only 77.3% of first-time LP shunts (p &lt; 0.0001). Mean hospital length of stay (LOS) significantly differed between primary VP (3 days) and primary LP shunt procedures (4 days, p &lt; 0.0001). The summed charges for the revisions of 92 VP shunts ($3,453,956) and those of the 6 VP shunt removals ($272,484) totaled $3,726,352 over 5 years for the study population. The summed charges for revision of 70 LP shunts ($2,229,430) and those of the 53 LP shunt removals ($3,125,569) totaled $5,408,679 over 5 years for the study population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The presented results appear to call into question the selection of LP shunt placement as primary treatment for IIH, as this procedure is associated with a significantly greater likelihood of need for shunt revision, increased LOS, and greater overall charges to the health care system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2014.8.focus14436","type":"journal-article","created":{"date-parts":[[2014,11,1]],"date-time":"2014-11-01T04:36:15Z","timestamp":1414816575000},"page":"E4","source":"Crossref","is-referenced-by-count":83,"title":["A comparison of lumboperitoneal and ventriculoperitoneal shunting for idiopathic intracranial hypertension: an analysis of economic impact and complications using the Nationwide Inpatient Sample"],"prefix":"10.3171","volume":"37","author":[{"given":"Richard P.","family":"Menger","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University of Health Sciences; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Connor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University of Health Sciences; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jai Deep","family":"Thakur","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University of Health Sciences; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Sonig","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University of Health Sciences; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elainea","family":"Smith","sequence":"additional","affiliation":[{"name":"Louisiana State University Health Shreveport School of Medicine, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharat","family":"Guthikonda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University of Health Sciences; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Nanda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University of Health Sciences; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14436","series-title":"Br J Neurosurg","first-page":"94","article-title":"Idiopathic intracranial hypertension: lumboperitoneal shunts versus ventriculoperitoneal shunts\u2014case series and literature review","volume":"25","author":"Abubaker","year":"2011"},{"key":"b2-focus14436","series-title":"AJNR Am J Neuroradiol","first-page":"952","article-title":"Transverse sinus stenting for pseudotumor cerebri: a cost comparison with CSF shunting","volume":"35","author":"Ahmed","year":"2014"},{"key":"b3-focus14436","series-title":"Horm Res Paediatr","first-page":"217","article-title":"Idiopathic intracranial hypertension and obesity","volume":"81","author":"Andrews","year":"2014"},{"key":"b4-focus14436","series-title":"J Neurosurg","first-page":"568","article-title":"Tonsillar herniation: the rule rather than the exception after lumboperitoneal shunting in the pediatric population","volume":"78","author":"Chumas","year":"1993"},{"key":"b5-focus14436","series-title":"Br J Neurosurg","first-page":"595","article-title":"Death from chronic tonsillar herniation in a patient with lumboperitoneal shunt and Crouzon's disease","volume":"6","author":"Chumas","year":"1992"},{"key":"b6-focus14436","series-title":"Neurosurgery","first-page":"97","article-title":"Rapidly rising incidence of cerebrospinal fluid shunting procedures for idiopathic intracranial hypertension in the United States, 1988\u20132002","volume":"57","author":"Curry","year":"2005"},{"issue":"5","key":"b7-focus14436","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension","volume":"23","author":"Feldon","year":"2007"},{"key":"b8-focus14436","series-title":"J Neuroophthalmol","first-page":"138","article-title":"Idiopathic intracranial hypertension","volume":"24","author":"Friedman","year":"2004"},{"key":"b9-focus14436","series-title":"Obes Rev","first-page":"e372","article-title":"Idiopathic intracranial hypertension in the USA: the role of obesity in establishing prevalence and healthcare costs","volume":"12","author":"Friesner","year":"2011"},{"key":"b10-focus14436","series-title":"Eur J Anaesthesiol","first-page":"298","article-title":"The effect of scalp block and local infiltration on the haemodynamic and stress response to skull-pin placement for craniotomy","volume":"26","author":"Geze","year":"2009"},{"key":"b11-focus14436","series-title":"J Neurosurg","first-page":"1179","article-title":"Application of electromagnetic technology to neuronavigation: a revolution in image-guided neurosurgery. Technical note","volume":"111","author":"Hayhurst","year":"2009"},{"key":"b12-focus14436","series-title":"World Neurosurg","first-page":"155","article-title":"Electromagnetic stereotactic ventriculoperitoneal CSF shunting for idiopathic intracranial hypertension: a successful step forward?","volume":"75","author":"Kandasamy","year":"2011"},{"key":"b13-focus14436","series-title":"Acta Neurochir (Wien)","first-page":"1193","article-title":"Lumboperitoneal shunts: are the complications acceptable?","volume":"146","author":"Karabatsou","year":"2004"},{"key":"b14-focus14436","series-title":"J Clin Neurosci","first-page":"50","article-title":"Image-guided placement of ventricular shunt catheter","volume":"13","author":"Kim","year":"2006"},{"key":"b15-focus14436","series-title":"J Neurosurg","first-page":"538","article-title":"Dural sinus stent placement for idiopathic intracranial hypertension. Clinical article","volume":"116","author":"Kumpe","year":"2012"},{"key":"b16-focus14436","series-title":"J Neurosurg","first-page":"899","article-title":"Use of programmable versus nonprogrammable shunts in the management of hydrocephalus secondary to aneurysmal subarachnoid hemorrhage: a retrospective study with cost-benefit analysis. Clinical article","volume":"121","author":"Lee","year":"2014"},{"key":"b17-focus14436","series-title":"J Neurosurg","first-page":"627","article-title":"Cerebrospinal fluid shunt placement for pseudotumor cerebri\u2013associated intractable headache: predictors of treatment response and an analysis of long-term outcomes","volume":"101","author":"McGirt","year":"2004"},{"key":"b18-focus14436","series-title":"Curr Neurol Neurosci Rep","first-page":"438","article-title":"Update on the surgical management of idiopathic intracranial hypertension","volume":"14","author":"Mukherjee","year":"2014"},{"key":"b19-focus14436","series-title":"Neurosurgery","first-page":"139","article-title":"Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment","volume":"56","author":"Patwardhan","year":"2005"},{"key":"b20-focus14436","series-title":"J Neurointerv Surg","first-page":"483","article-title":"Venous sinus stenting for idiopathic intracranial hypertension: a review of the literature","volume":"5","author":"Puffer","year":"2013"},{"key":"b21-focus14436","series-title":"Stereotact Funct Neurosurg","first-page":"97","article-title":"Stereotactic placement of ventricular catheters: does it affect proximal malfunction rates?","volume":"90","author":"Sampath","year":"2012"},{"key":"b22-focus14436","series-title":"Clin Neurol Neurosurg","first-page":"477","article-title":"Is there a difference in outcomes of patients with idiopathic intracranial hypertension with the choice of cerebrospinal fluid diversion site: a single centre experience","volume":"113","author":"Tarnaris","year":"2011"},{"key":"b23-focus14436","series-title":"JAMA","first-page":"1514","article-title":"Escalating obesity rates pose health, budget threats","volume":"308","author":"Voelker","year":"2012"},{"key":"b24-focus14436","series-title":"J Surg Case Rep","first-page":"7","article-title":"Resolution of pseudotumor cerebri following surgery for morbid obesity","author":"Williams","year":"2010"},{"key":"b25-focus14436","series-title":"J Neurosurg","first-page":"66","article-title":"Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation. 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Technical note","volume":"111","author":"Hayhurst","year":"2009"},{"key":"b12-focus14436","series-title":"World Neurosurg","first-page":"155","article-title":"Electromagnetic stereotactic ventriculoperitoneal CSF shunting for idiopathic intracranial hypertension: a successful step forward?","volume":"75","author":"Kandasamy","year":"2011"},{"key":"b13-focus14436","series-title":"Acta Neurochir (Wien)","first-page":"1193","article-title":"Lumboperitoneal shunts: are the complications acceptable?","volume":"146","author":"Karabatsou","year":"2004"},{"key":"b14-focus14436","series-title":"J Clin Neurosci","first-page":"50","article-title":"Image-guided placement of ventricular shunt catheter","volume":"13","author":"Kim","year":"2006"},{"key":"b15-focus14436","series-title":"J Neurosurg","first-page":"538","article-title":"Dural sinus stent placement for idiopathic intracranial hypertension. 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Clinical article","volume":"121","author":"Lee","year":"2014"},{"key":"b17-focus14436","series-title":"J Neurosurg","first-page":"627","article-title":"Cerebrospinal fluid shunt placement for pseudotumor cerebri\u2013associated intractable headache: predictors of treatment response and an analysis of long-term outcomes","volume":"101","author":"McGirt","year":"2004"},{"key":"b18-focus14436","series-title":"Curr Neurol Neurosci Rep","first-page":"438","article-title":"Update on the surgical management of idiopathic intracranial hypertension","volume":"14","author":"Mukherjee","year":"2014"},{"key":"b19-focus14436","series-title":"Neurosurgery","first-page":"139","article-title":"Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment","volume":"56","author":"Patwardhan","year":"2005"},{"key":"b20-focus14436","series-title":"J Neurointerv Surg","first-page":"483","article-title":"Venous sinus stenting for idiopathic intracranial hypertension: a review of the literature","volume":"5","author":"Puffer","year":"2013"},{"key":"b21-focus14436","series-title":"Stereotact Funct Neurosurg","first-page":"97","article-title":"Stereotactic placement of ventricular catheters: does it affect proximal malfunction rates?","volume":"90","author":"Sampath","year":"2012"},{"key":"b22-focus14436","series-title":"Clin Neurol Neurosurg","first-page":"477","article-title":"Is there a difference in outcomes of patients with idiopathic intracranial hypertension with the choice of cerebrospinal fluid diversion site: a single centre experience","volume":"113","author":"Tarnaris","year":"2011"},{"key":"b23-focus14436","series-title":"JAMA","first-page":"1514","article-title":"Escalating obesity rates pose health, budget threats","volume":"308","author":"Voelker","year":"2012"},{"key":"b24-focus14436","series-title":"J Surg Case Rep","first-page":"7","article-title":"Resolution of pseudotumor cerebri following surgery for morbid obesity","author":"Williams","year":"2010"},{"key":"b25-focus14436","series-title":"J Neurosurg","first-page":"66","article-title":"Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation. 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