Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature
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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.
KeywordsIdiopathic intracranial hypertension Pseudotumour cerebri Surgical interventions Efficacy Complications Cost of intervention
Body mass index
High dependency unit
Health-related quality of life
Idiopathic intracranial hypertension
Laparoscopic adjustable gastric banding
Length of hospital stay
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
Compliance with ethical standards
No funding was received for this research.
Conflict of interest
For this type of study formal consent is not required.
- 4.Ahmed RM, Wilkinson M, Parker GD, Thurtell MJ, Macdonald J, McCluskey PJ, Allan R, Dunne V, Hanlon M, Owler BK, Halmagyi GM (2011) Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. AJNR Am J Neuroradiol 32:1408–1414CrossRefPubMedGoogle Scholar
- 20.Department of Health (2013) NHS reference costs. NHS reference costs 2012 to 2013. Available at https://www.gov.uk/government/publications/nhs-reference-costs-2012-to-2013. Accessed 18 Aug 2016
- 44.Lueck CJ, McIlwaine GG (2005) Interventions for idiopathic intracranial hypertension. Cochrane Database Systematic Rev (3). doi: 10.1002/14651858.CD003434.pub2
- 49.NHS, institute for innovation and improvement (2013) The productive operative theatre. Available at http://www.institute.nhs.uk/quality_and_value/productivity_series/the_productive_operating_theatre.html. Accessed 18 Aug 2016
- 51.Orefice G, Celentano L, Scaglione M, Davoli M, Striano S (1992) Radioisotopic cisternography in benign intracranial hypertension of young obese women. A seven-case study and pathogenetic suggestions. Acta Neurol (Napoli) 14:39–50Google Scholar
- 56.Radvany MG, Solomon D, Nijjar S, Subramanian PS, Miller NR, Rigamonti D, Blitz A, Gailloud P, Moghekar A (2013) Visual and neurological outcomes following endovascular stenting for pseudotumor cerebri associated with transverse sinus stenosis. J Neuroophthalmol 33:117–122CrossRefPubMedGoogle Scholar
- 59.Scotland Information Services Division (2013) Scottish National Tariffs. Available at http://www.isdscotland.org/Health%2DTopics/Finance/Scottish%2DNational%2DTariff/. Accessed 18 Aug 2016