Treatment of idiopathic intracranial hypertension with bariatric surgery

Abstract Introduction Idiopathic Intracranial Hypertension (IIH) is a significant cause of preventable blindness. Patients also suffer from debilitating headaches, pulsatile tinnitus, nausea, vomiting, photophobia, and radicular pain. If IIH continues to rise as predicted, treatment cost will increase to 462.7 million GBP annually by 2030. Weight loss is the only proven disease-modifying therapy for reversal of IIH. Bariatric surgery is an attractive treatment option due to superlative weight loss and reversal of related comorbidities. The case series aims to raise awareness of bariatric surgery as a safe and effective treatment modality for IIH. Method The case series consists of a retrospective analysis of four patients with a pre-operative diagnosis of IIH. They were referred to our department for bariatric surgery between January to December 2018. They were followed up for a total of two years. Results In our case series, all four patients were females with a mean age of 34 years. Mean BMI reduced from 47.3 kg/m2 before surgery to 30 kg/m2 with an EWL of 76.4% at the end of two years after surgery. They all showed significant improvement or resolution in their symptoms related to IIH, and none of them required further CSF pressure reducing procedures afterwards. Conclusions Bariatric surgery is a safe and effective method of treating IIH. It is superior compared to medical management and CSF pressure reducing procedures which have high rates of recurrence.

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Idiopathic intracranial hypertension and bariatric surgery: a literature review and a presentation of two cases

British Journal of Neurosurgery ◽

10.1080/02688697.2018.1427211 ◽

2018 ◽

Vol 33 (1) ◽

pp. 112-114 ◽

Cited By ~ 5

Author(s):

Francois Okoroafor ◽

Muhammad Ali Karim ◽

Abdulmajid Ali

Keyword(s):

Bariatric Surgery ◽

Literature Review ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension

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A219 Positive Effects of Bariatric Surgery on Idiopathic Intracranial Hypertension

Surgery for Obesity and Related Diseases ◽

10.1016/j.soard.2019.08.164 ◽

2019 ◽

Vol 15 (10) ◽

pp. S78-S79

Author(s):

Essa Aleassa ◽

Charles Keith ◽

Ali Aminian ◽

Philip Schauer

Keyword(s):

Bariatric Surgery ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Positive Effects

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Idiopathic intracranial hypertension and bariatric surgery: a systematic review

Canadian Journal of Surgery ◽

10.1503/cjs.016616 ◽

2020 ◽

Vol 63 (2) ◽

pp. E123-E128

Author(s):

Warren Y. L. Sun ◽

Noah J. Switzer ◽

Jerry T. Dang ◽

Richdeep Gill ◽

Xinzhe Shi ◽

...

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension

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Bariatric surgery for the treatment of idiopathic intracranial hypertension

Journal of Neurosurgery ◽

10.3171/2009.12.jns09953 ◽

2011 ◽

Vol 114 (1) ◽

pp. 34-39 ◽

Cited By ~ 79

Author(s):

Jared Fridley ◽

Rod Foroozan ◽

Vadim Sherman ◽

Mary L. Brandt ◽

Daniel Yoshor

Keyword(s):

Bariatric Surgery ◽

Body Mass Index ◽

Weight Loss ◽

Visual Field ◽

Intracranial Hypertension ◽

Body Mass ◽

Idiopathic Intracranial Hypertension ◽

Obese Patients ◽

Symptom Resolution ◽

Visual Field Deficits

Object The purpose of this study was to review the literature on the effectiveness of bariatric surgery for obese patients with idiopathic intracranial hypertension (IIH) with regard to both symptom resolution and resolution of visual deficits. Methods The published literature was reviewed using manual and electronic search techniques. Data from each relevant manuscript were gathered, analyzed, and compared. These included demographic data, pre- and postoperative symptoms, pre- and postoperative visual field deficits, bariatric procedure type, absolute weight loss, changes in body mass index, and changes in CSF opening pressure. Results Eleven relevant publications (including 6 individual case reports) were found, reporting on a total of 62 patients. The Roux-en-Y gastric bypass was the most common bariatric procedure performed. Fifty-six (92%) of 61 patients with recorded postoperative clinical history had resolution of their presenting IIH symptoms following bariatric surgery. Thirty-four (97%) of 35 patients who had undergone pre- and postoperative funduscopy were found to have resolution of papilledema postoperatively. Eleven (92%) of 12 patients who had undergone pre- and postoperative formal visual field testing had complete or nearly complete resolution of visual field deficits, and the remaining patient had stabilization of previously progressive vision loss. In 13 patients both pre- and postoperative CSF pressures were recorded, with an average postoperative pressure decrease of 254 mm H2O. Changes in weight loss and body mass index varied depending on the reported postoperative follow-up interval. Conclusions The published Class IV evidence suggests that bariatric surgery may be an effective treatment for IIH in obese patients, both in terms of symptom resolution and visual outcome. Prospective, controlled studies are necessary for better elucidation of its role.

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Obstructive sleep apnoea in women with idiopathic intracranial hypertension: a sub-study of the idiopathic intracranial hypertension weight randomised controlled trial (IIH: WT)

Journal of Neurology ◽

10.1007/s00415-021-10700-9 ◽

2021 ◽

Author(s):

Andreas Yiangou ◽

James L. Mitchell ◽

Matthew Nicholls ◽

Yu Jeat Chong ◽

Vivek Vijay ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Intracranial Hypertension ◽

Obstructive Sleep Apnoea ◽

Idiopathic Intracranial Hypertension ◽

Epworth Sleepiness Scale ◽

Sleep Apnoea ◽

Screening Tools ◽

Obstructive Sleep ◽

Randomised Controlled

Abstract Objective Obesity is a risk factor for idiopathic intracranial hypertension (IIH) and obstructive sleep apnoea (OSA). We aimed to determine the prevalence of OSA in IIH and evaluate the diagnostic performance of OSA screening tools in IIH. Additionally, we evaluated the relationship between weight loss, OSA and IIH over 12 months. Methods A sub-study of a multi-centre, randomised controlled parallel group trial comparing the impact of bariatric surgery vs. community weight management intervention (CWI) on IIH-related outcomes over 12 months (IIH:WT). OSA was assessed using home-based polygraphy (ApneaLink Air, ResMed) at baseline and 12 months. OSA was defined as an apnoea–hypopnoea index (AHI) ≥ 15 or ≥ 5 with excessive daytime sleepiness (Epworth Sleepiness Scale ≥11 ). Results Of the 66 women in the IIH: WT trial, 46 were included in the OSA sub-study. OSA prevalence was 47% (n = 19). The STOP-BANG had the highest sensitivity (84%) compared to the Epworth Sleepiness Scale (69%) and Berlin (68%) to detect OSA. Bariatric surgery resulted in greater reductions in AHI vs. CWI (median [95%CI] AHI reduction of – 2.8 [ – 11.9, 0.7], p = 0.017). Over 12 months there was a positive association between changes in papilloedema and AHI (r = 0.543, p = 0.045), despite adjustment for changes in the body mass index (R2 = 0.522, p = 0.017). Conclusion OSA is common in IIH and the STOP-BANG questionnaire was the most sensitive screening tool. Bariatric surgery improved OSA in patients with IIH. The improvement in AHI was associated with improvement in papilloedema independent of weight loss. Whether OSA treatment has beneficial impact on papilloedema warrants further evaluation. Trial registration number IIH: WT is registered as ISRCTN40152829 and on ClinicalTrials.gov as NCT02124486 (28/04/2014).

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Idiopathic Intracranial Hypertension: Evaluation of Admissions and Emergency Readmissions through the Hospital Episode Statistic Dataset between 2002–2020

Life ◽

10.3390/life11050417 ◽

2021 ◽

Vol 11 (5) ◽

pp. 417

Author(s):

Susan P. Mollan ◽

Jemma Mytton ◽

Georgios Tsermoulas ◽

Alex J. Sinclair

Keyword(s):

Bariatric Surgery ◽

Optic Nerve ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Hospital Episode Statistics ◽

Optic Nerve Sheath ◽

Shunt Revision ◽

Hospital Episode ◽

Optic Nerve Sheath Fenestration ◽

Nerve Sheath

With increasing incidence and prevalence of Idiopathic intracranial hypertension in the UK, the aim of this study was to explore emerging themes in Idiopathic intracranial hypertension using the Hospital Episode Statistics dataset and to quantify recent change in hospital admissions and surgeries performed within England. Methods: Hospital Episode Statistics national data was extracted between 1 April 2002 and 31 March 2019, and followed up until 31 March 2020. All those within England with a diagnosis of Idiopathic Intracranial Hypertension were included. Those with secondary causes of raised intracranial pressure such as tumors, hydrocephalus and cerebral venous sinus thrombosis were excluded. Results: 28,794 new IIH cases were diagnosed between 1 January 2002 and 31 December 2019. Incidence rose between 2002 to 2019 from 1.8 to 5.2 per 100,000 in the general population. Peak incidence occurred in females aged 25–29 years. Neurosurgical shunt was the commonest procedure performed (6.4%), followed by neovascular venous sinus stenting (1%), bariatric surgery (0.8%) and optic nerve sheath fenestration (0.5%). The portion of the total IIH population requiring a shunt fell from 10.8% in 2002/2003 to 2.46% in 2018/2019. The portion of the total IIH population requiring shunt revision also reduced over time from 4.84% in 2002/2003 to 0.44% in 2018/2019. The mean 30 days emergency readmissions for primary shunt, revision of shunt, bariatric surgery, neurovascular stent, and optic nerve sheath fenestration was 23.1%, 23.7%, 10.6%, 10.0% and 9.74%, respectively. There was a peak 30 days readmission rate following primary shunt in 2018/2019 of 41%. Recording of severe visual impairment fell to an all-time low of 1.38% in 2018/19. Conclusions: Increased awareness of the condition, specialist surgery and expert guidance may be changing admissions and surgical trends in IIH. The high 30 readmission following primary shunt surgery for IIH requires further investigation.

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