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25.04.2020 | Review

A systematic review of surgical treatments of idiopathic intracranial hypertension (IIH)

verfasst von: Aristotelis Kalyvas, Eleftherios Neromyliotis, Christos Koutsarnakis, Spyridon Komaitis, Evangelos Drosos, Georgios P. Skandalakis, Mantha Pantazi, Y. Pierre Gobin, George Stranjalis, A. Patsalides

Erschienen in: Neurosurgical Review | Ausgabe 2/2021

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Abstract

Idiopathic intracranial hypertension denotes raised intracranial pressure in the absence of an identifiable cause and presents with symptoms relating to elevated ICP, namely headaches and visual deterioration. Treatment of IIH aims at reducing intracranial pressure, relieving headache and salvaging patients’ vision. Surgical interventions are recommended for medically refractory IIH and include CSF diversion techniques, optic nerve sheath fenestration, bariatric surgery and venous sinus stenting. Prospective studies on the surgical options for IIH are scant and no evidence-based guidelines for the surgical management of medically refractory IIH have been established. A search in Cochrane Library, MEDLINE and EMBASE from 1 January 1985 to 19 April 2019 for controlled or observational studies on the surgical treatment of IIH (defined in accordance with the modified Dandy or the modified Friedman criteria) in adults yielded 109 admissible studies. VSS improved papilledema, visual fields and headaches in 87.1%, 72.7% and 72.1% of the patients respectively, with a 2.3% severe complication rate and 11.3% failure rate. CSF diversion techniques diminished papilledema, visual field deterioration and headaches in 78.9%, 66.8% and 69.8% of the cases and are associated with a 9.4 severe complication rate and a 43.4% failure rate. ONSF ameliorated papilledema, visual field defects and headaches in 90.5, 65.2% and 49.3% of patients. Severe complication rate was 2.2% and failure rate was 9.4%. This is currently the largest systematic review for the available operative modalities for IIH. VSS provided the best results in headache resolution and visual outcomes, with low failure rates and a very favourable complication profile. In light of this, VSS ought to be regarded as the first-line surgical modality for the treatment of medically refractory IIH.

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Titel: A systematic review of surgical treatments of idiopathic intracranial hypertension (IIH)
verfasst von: Aristotelis Kalyvas
Eleftherios Neromyliotis
Christos Koutsarnakis
Spyridon Komaitis
Evangelos Drosos
Georgios P. Skandalakis
Mantha Pantazi
Y. Pierre Gobin
George Stranjalis
A. Patsalides
Publikationsdatum: 25.04.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Neurosurgical Review / Ausgabe 2/2021
Print ISSN: 0344-5607
Elektronische ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-020-01288-1

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