Want to dive even deeper? Check out our

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 4th 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

Related Research

Doctor looking at xrays
June 16, 2022
A summary of the link between Transverse sinus stenosis and IIH with links to further reading....
Male scientist with microscope
June 16, 2022
A summary of the The Idiopathic Intracranial Hypertension Treatment Trial (IIHTT), its significance, and links to further reading....

You are not alone

This hub is filled with resources to help you navigate IIH. Sign up for our mailing list to receive monthly updates about new tools and resources.

Patient stories

“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.”
“Knowing your diagnosis and following the latest science and research is crucial in a world where you will encounter medical professionals who have never seen an IIH case.”

Like what you are seeing?

Join our next webinar.

Thank you! You’re registration is complete for:

IIH Community Chat

Discussion on navigating through the healthcare system

April 25 at 10am ET