Acta Neurochirurgica

, Volume 159, Issue 1, pp 33–49 | Cite as

Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature

  • Aristotelis V. Kalyvas
  • Mark Hughes
  • Christos Koutsarnakis
  • Demetrios Moris
  • Faidon Liakos
  • Damianos E. Sakas
  • George Stranjalis
  • Ioannis Fouyas
Review Article - Neurosurgical Techniques



To define the efficacy, complication profile and cost of surgical options for treating idiopathic intracranial hypertension (IIH) with respect to the following endpoints: vision and headache improvement, normal CSF pressure restoration, papilloedema resolution, relapse rate, operative complications, cost of intervention and quality of life.


A systematic review of the surgical treatment of IIH was carried out. Cochrane Library, MEDLINE and EMBASE databases were systematically searched from 1985 to 2014 to identify all relevant manuscripts written in English. Additional studies were identified by searching the references of retrieved papers and relative narrative reviews.


Forty-one (41) studies were included (36 case series and 5 case reports), totalling 728 patients. Three hundred forty-one patients were treated with optic nerve sheath fenestration (ONSF), 128 patients with lumboperitoneal shunting (LPS), 72 patients with ventriculoperitoneal shunting (VPS), 155 patients with venous sinus stenting and 32 patients with bariatric surgery. ONSF showed considerable efficacy in vision improvement, while CSF shunting had a superior headache response. Venous sinus stenting demonstrated satisfactory results in both vision and headache improvement along with the best complication profile and low relapse rate, but longer follow-up periods are needed. The complication rate of bariatric surgery was high when compared to other interventions and visual outcomes have not been reported adequately. ONSF had the lowest cost.


No surgical modality proved to be clearly superior to any other in IIH management. However, in certain contexts, a given approach appears more justified. Therefore, a treatment algorithm has been formulated, based on the extracted evidence of this review. The traditional treatment paradigm may need to be re-examined with sinus stenting as a first-line treatment modality.


Idiopathic intracranial hypertension Pseudotumour cerebri Surgical interventions Efficacy Complications Cost of intervention 



Body mass index


Cerebrospinal fluid


High dependency unit


Health-related quality of life


Intracranial pressure


Idiopathic intracranial hypertension


Laparoscopic adjustable gastric banding


Length of hospital stay


Lumboperitoneal shunting


Laparoscopic Roux-en-Y gastric bypass


Magnetic resonance imaging


Magnetic resonance venography


National health service


Optic nerve sheath fenestration


Participants, Interventions, Comparisons, Outcomes, Studies


Preferred Reporting Items for Systematic Reviews and Meta-Analyses


Randomised control trial


Revision per patient rate


Stereotactic ventriculoperitoneal shunting


Ventriculoperitoneal shunting


Compliance with ethical standards


No funding was received for this research.

Conflict of interest


Ethical approval

For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Aristotelis V. Kalyvas
    • 1
    • 2
  • Mark Hughes
    • 1
    • 3
  • Christos Koutsarnakis
    • 3
    • 4
  • Demetrios Moris
    • 5
  • Faidon Liakos
    • 2
    • 4
  • Damianos E. Sakas
    • 2
  • George Stranjalis
    • 2
    • 4
  • Ioannis Fouyas
    • 1
    • 3
  1. 1.University of EdinburghEdinburghUK
  2. 2.Department of NeurosurgeryUniversity of Athens, Evangelismos HospitalAthensGreece
  3. 3.Department of Clinical NeuroscienceWestern General HospitalEdinburghUK
  4. 4.Hellenic Center for Neurosurgical Research “Prof. Petros Kokkalis”AthensGreece
  5. 5.Lerner Research Institute, Cleveland Clinic FoundationClevelandUSA

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