Elsevier

Surgery for Obesity and Related Diseases

Volume 11, Issue 6, November–December 2015, Pages 1396-1403
Surgery for Obesity and Related Diseases

Review article
Bariatric surgery as a treatment for idiopathic intracranial hypertension: a systematic review

https://doi.org/10.1016/j.soard.2015.08.497Get rights and content

Abstract

Background

Idiopathic intracranial hypertension (IIH) is a chronic neurologic disease that may result in persistent and debilitating symptoms that are refractory to conventional treatments.

Objectives

The aim of this study was to systematically review the effect of bariatric weight reduction surgery as a treatment for IIH.

Methods

A comprehensive literature search was conducted using the following databases: MEDLINE, EMBASE, PubMed, Scopus, Web of Sciences, and the Cochrane Library. No restrictions were placed on these searches, including the date of publication.

Results

A total of 85 publications were identified, and after initial appraisal, 17 were included in the final review. Overall improvement in symptoms of IIH after bariatric surgery was observed in 60 of the 65 patients observed (92%). Postoperative lumbar puncture opening pressure was shown to decrease by an average of 18.9 cmH2 O in the 12 patients who had this recorded.

Conclusion

Bariatric surgery for weight loss is associated with alleviation of IIH symptoms and a reduction in intracranial pressure. Furthermore, an improvement was observed in patients where conventional treatments, including neurosurgery, were ineffective. Further prospective randomized studies with control groups and a larger number of participants are lacking within the published studies to date. There is, therefore, a strong rationale for the use of bariatric surgery in individuals with IIH for the effective treatment of this condition, as well as the efficacy of weight loss for various other obesity co-morbidities.

Section snippets

Protocol and registration

This review was conducted in accordance with the widely accepted PRISMA 2009 protocol, which is openly available from a number of sources. This review was registered through the PROSPERO Systematic Review Data Repository (SRDR) initiative (available at http://www.crd.york.ac.uk/PROSPERO); the registration number is CRD42015020446.

Eligibility criteria

Studies in all languages were considered, and searches also included material that had not been formally published (grey literature) such as conference proceedings.

Search criteria

Study selection and characteristics

A total of 85 papers were screened, and 17 were included in the final review. Of these, 6 studies and 11 case reports were found involving a total of 67 patients. Two larger studies that investigated the effects of bariatric surgery on various co-morbidities of obesity, including IIH, were excluded, because they did not include any postoperative data on changes in symptoms of IIH [14], [15]. Two additional review papers were also acknowledged and assimilated; however, these did not contain any

Discussion

Michaelides et al. [31] conducted a retrospective study by searching 2 databases of>2000 patients to find 16 females with morbid obesity and pulsatile tinnitus who had undergone bariatric surgery. While the main endpoint was resolution of pulsatile tinnitus, this symptom was assumed to be secondary to PTC syndrome and arguably took a more pragmatic approach toward symptom control rather than simply a reduction in ICP. Fundoscopy and LP performed in 12 of these patients were able to confirm

Conclusion

To our knowledge, this is the first published systematic review that examines the role of bariatric surgery as a treatment for IIH. It also builds upon 2 previous review articles through the addition of a number of further studies and case reports. What can reliably be concluded from this systematic review is that bariatric surgery has been shown to be successful and even superior to other treatments of IIH with high failure rates associated with conventional therapies such as weight loss by

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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