1338 Bariatric Surgery as a Viable Treatment for Idiopathic Intracranial Hypertension: A Case Series

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Mahendran ◽  
P Ricart ◽  
M Wadley ◽  
A Perry ◽  
S Robinson
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Case Series ◽  
Radicular Pain ◽  
Csf Pressure ◽  
Disease Modifying Therapy ◽  
Effective Treatment Modality ◽  
Preventable Blindness

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.

Bariatric surgery for the treatment of idiopathic intracranial hypertension

2011 ◽  
Vol 114 (1) ◽  
pp. 34-39 ◽  
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.

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

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).

scholarly journals Randomised controlled trial of bariatric surgery versus a community weight loss programme for the sustained treatment of idiopathic intracranial hypertension: the Idiopathic Intracranial Hypertension Weight Trial (IIH:WT) protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017426 ◽  
Author(s):  
Ryan Ottridge ◽  
Susan P Mollan ◽  
Hannah Botfield ◽  
Emma Frew ◽  
Natalie J Ives ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Secondary Outcome ◽  
Controlled Clinical Trial ◽  
Link Type ◽  
Long Term Treatment ◽  
Weight Loss Programme ◽  
Randomised Controlled

IntroductionEffective treatments are lacking for idiopathic intracranial hypertension (IIH), a condition characterised by raised intracranial pressure (ICP) and papilloedema, and found primarily in obese women. Weight loss and lowering body mass index (BMI) have been shown to lower ICP and improve symptoms in IIH; however, weight loss is typically not maintained, meaning IIH symptoms return. The Idiopathic Intracranial Hypertension Weight Trial (IIH:WT) will assess whether bariatric surgery is an effective long-term treatment for patients with IIH with a BMI over 35 kg/m2. The National Institute for Health and Care Excellence recommends bariatric surgery in people with a BMI over 35 kg/m2and a qualifying comorbidity; currently IIH does not qualify as a comorbidity.Methods and analysisIIH:WT is a multicentre, open-label, randomised controlled clinical trial of 64 participants with active IIH and a BMI over 35 kg/m2. Participants will be randomised in a 1:1 ratio to bariatric surgery or a dietary weight loss programme and followed up for 5 years. The primary outcome measure is ICP at 12 months. Secondary outcome measures include ICP at 24 and 60 months, and IIH symptoms, visual function, papilloedema, headache, quality of life and cost-effectiveness at 12, 24 and 60 months.Trial registration numberIIH:WT is registered asISRCTN40152829and on ClinicalTrials.gov asNCT02124486and is in the pre-results stage.

scholarly journals Shunt freedom and clinical resolution of idiopathic intracranial hypertension after bariatric surgery in the pediatric population: report of 3 cases

2017 ◽  
Vol 20 (6) ◽  
pp. 511-516 ◽  
Author(s):  
Kimberly B. Hoang ◽  
Kristopher G. Hooten ◽  
Carrie R. Muh
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Pediatric Population ◽  
Pseudotumor Cerebri ◽  
Optic Nerve Sheath Fenestration ◽  
Csf Shunting ◽  
Duke University ◽  
Weight Loss Interventions

Idiopathic intracranial hypertension (IIH), formerly known as pseudotumor cerebri, is a disease of elevated intracranial pressure that is thought to develop due to impaired CSF absorption related to elevated venous sinus pressure in the setting of increased intraabdominal and thoracic pressures. Symptoms can be disabling and, if left untreated, can lead to permanent visual loss. Previous treatments directed toward vision preservation include CSF diversion through shunting and optic nerve sheath fenestration. Recently, attention has been turned toward surgical weight loss strategies as an alternative to shunt treatment. The authors present a report of 3 patients with adolescent-onset IIH that was treated at the authors’ institution (Duke University) in whom bariatric surgery was pursued successfully. The patients had previously undergone CSF shunting at ages 12, 15, and 23 years. They were shunt dependent for a collective average of 3.3 years prior to bariatriwc surgery. All patients reported “low-pressure” or postural headaches after bariatric surgery that correlated with dramatic reduction in their weight. Two of the 3 patients had their shunts removed and continued to be shunt free 1.5 years later at last follow-up; the third patient remained shunt dependent with the pressure set at 200 mm H2O. Given the significant complications inherent to multiple shunt revisions, earlier intervention for weight loss, including bariatric surgery, in these patients might have prevented complications and the associated health care burden. The authors recommend a multidisciplinary approach for IIH treatment with early consideration for weight loss interventions in select patients.

scholarly journals Bariatric Surgery or Non-surgical Weight Loss for Idiopathic Intracranial Hypertension? A Systematic Review and Comparison of Meta-analyses

2016 ◽  
Vol 27 (2) ◽  
pp. 513-521 ◽  
Author(s):  
James H. Manfield ◽  
Kenny K-H. Yu ◽  
Evangelos Efthimiou ◽  
Ara Darzi ◽  
Thanos Athanasiou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Weight Loss ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Surgical Weight Loss ◽  
Meta Analyses

The Potentially Modifiable Risk Factor in Idiopathic Intracranial Hypertension: Body Weight

2021 ◽  
pp. 10.1212/CPJ.0000000000001063
Author(s):  
Susan P Mollan ◽  
Abd A Tahrani ◽  
Alexandra J Sinclair
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Risk Factor ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Treatment Strategy ◽  
Idiopathic Intracranial Hypertension ◽  
Potential Treatment ◽  
Distal Small Intestine

AbstractPurpose of review:Idiopathic intracranial hypertension (IIH) prevalence increased in conjunction with rising obesity rates. Here, we highlight the importance of weigh management in IIH, and introduce glucagon-like peptide 1 (GLP-1) receptor agonists (RA) as potential treatment strategy for IIH.Recent findings:Weight gain is a risk factor for IIH; and weight loss (via any treatment strategy) plays a key role in IIH management. GLP-1 is an incretin secreted by the distal small intestine in response to a meal. GLP-1 RA have been shown to improve glycaemic control (no. hypoglycaemia) and lower body weight in patients with and without type 2 diabetes. The choroid plexus has been found to express GLP-1 receptors and treatment with a GLP-1 RA significantly reduces cerebrospinal fluid secretion in vitro and intracranial pressure in rodents.Summary:New research evaluating the pathophysiology of IIH supports GLP-1 RA as a potential treatment for IIH via weight loss dependant and independent mechanism to directly reduce intracranial pressure.

Idiopathic intracranial hypertension in pediatric population: Case series from India

2013 ◽  
Vol 61 (5) ◽  
pp. 488 ◽  
Author(s):  
ArunGrace Roy ◽  
KollencheriPuthenveettil Vinayan ◽  
Anand Kumar
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Pediatric Population ◽  
Case Series
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