A Systematic Review of Surgical Treatments of IIH

Neurological Review,

Kalyvas et al.

This review compares the results of the three main surgeries to treat IIH patients who have failed medical therapy.

Summary

A systematic review is the questioning of the large databases of the medical literature to analyze all the published articles on a specific subject.

This review compares the results of the three main surgeries to treat IIH patients who have failed medical therapy. The three main procedures to treat IIH are: shunting of the cerebrospinal fluid (shunting), optic nerve sheath fenestration (ONSF) and venous sinus stenting (VSS). Additionally, the study also included a few cases of morbidly obese patients who underwent bariatric surgery to lose weight. This review included 2302 patients.

The authors analyzed the results of these surgeries on various symptoms and examination findings of IIH such as papilledema, visual field deterioration, and headaches. They also analyzed the rate of severe complications and the rate of recurrence (deterioration after initial improvement). The results are summarized in the table below.

Papilledema improvedVisual field improvedHeadaches improvedSevere complicationsRecurrences

ONSF	90.5%	65.2%	49.3%	2.2%	9.4%
Shunting	78.9%	66.8%	69.8%	9.4%	39.1%
VSS	87.1%	72.7%	72.1%	2.3%	13.1%

For the 4^th procedure, bariatric surgery, few patients had ophthalmologic examinations so the statistics are not reliable, but most patients (42/45) had improvement of their headaches.

The authors concluded that shunting is the most frequent procedure to treat IIH symptoms,, provides good improvement of headaches and visual signs, but has high failure and complication rates. ONSF is very effective on visual symptoms and has few severe complications but is not very effective in treating headaches. VSS had the best results in improving the visual symptoms and headaches and had less recurrences than shunting. However, some complications of VSS were very severe and the authors proposed that new devices were needed to perform VSS more safely. Finally, they propose that “VSS should be the first-line surgical treatment in patients with medically refractory IIH”.

Kalyvas et al., A systematic review of surgical treatments of idiopathic intracranial hypertension (IIH), Neurological Review 44, p 773–792, (2021). https://doi.org/10.1007/s10143-020-01288-1

Y. Pierre Gobin M.D.

Y. Pierre Gobin, MD is an Interventional Neuroradiologist with over 30 years experience. He is the co-inventor of the Merci retriever, Cooling catheter, and IA chemotherapy for retinoblastoma. Pierre is also Co-founder for Concentric Medical and Lazarus Effect.

All Articles >

Related Research

June 16, 2022

Transverse Sinus Stenosis and IIH

A summary of the link between Transverse sinus stenosis and IIH with links to further reading....

June 16, 2022

IIHTT Clinical Trial

A summary of the The Idiopathic Intracranial Hypertension Treatment Trial (IIHTT), its significance, and links to further reading....

June 16, 2022

A Systematic Review of Surgical Treatments of IIH

This review compares the results of the three main surgeries to treat IIH patients who have failed medical therapy....

Patient stories

Jim

“My instincts told me that I had to keep pushing and that I had to keep my body as active as possible because I didn’t know where all of this was leading. “

Nicole

“I know everyone says to trust your gut, so I’ll say trust your headache. Your pain is real, and ‘borderline-ish’ does not serve anyone.”

A Systematic Review of Surgical Treatments of IIH

Neurological Review,

Kalyvas et al.

Summary

Patient stories

Like what you are seeing?

Join our next webinar.

Thank you! You’re registration is complete for:

IIH Practitioner Series