Obesity Surgery

, Volume 21, Issue 2, pp 161–166 | Cite as

The Effects of Laparoscopic Adjustable Gastric Banding on Idiopathic Intracranial Hypertension

  • Richard J. EganEmail author
  • Hayley E. Meredith
  • James E. Coulston
  • Luke Bennetto
  • Justin D. T. Morgan
  • Sally A. Norton
Clinical Report


The purpose of this study was to determine whether laparoscopic adjustable gastric banding has a role in the treatment of idiopathic intracranial hypertension. This pilot study was undertaken in a single, tertiary referral centre. Data on all patients with idiopathic intracranial hypertension that have undergone laparoscopic adjustable gastric banding in our unit were collected from our prospectively maintained bariatric database. Additional information was obtained via telephone questionnaires and review of medical records. Four female patient with a mean age of 32 years (range 29–39 years) and mean pre-operative body mass index of 46.1 kg/m2 (range 38.2–54.0 kg/m2) underwent laparoscopic adjustable gastric banding between June 2006 and July 2009. At a mean follow-up of 19.8 months all four patients reported either total resolution of headache or significant improvement in headache, with a mean improvement in pain score of 76.3/100 (range 55–95) on a analogue pain score. Mean excess weight loss at follow-up was 64.1% (range 50.1–88.2%). There were no complications or mortality in this cohort. This study suggests that laparoscopic adjustable gastric banding represents an effective and safe treatment for idiopathic intracranial hypertension associated with morbid obesity. We have shown good results both in terms of symptom resolution and weight loss, whilst avoiding alimentary tract diversion procedures in these young female patients. A randomized, controlled trial can be justified on the basis of this initial pilot study.


Gastric banding Idiopathic intracranial hypertension Obesity-related co-morbidities 



Idiopathic intracranial hypertension


Cerebrospinal fluid


Laparoscopic adjustable gastric banding


National Health Service


National Institute for Health and Clinical Excellence


Body mass index


United Kingdom


Conflict of Interest

The authors declare no conflicts of interest in relation to this manuscript


  1. 1.
    Dhungana S, Sharrack B, Woodroofe N. Idiopathic intracranial hypertension. Acta Neurol Scand. 2010;121:71–82.CrossRefPubMedGoogle Scholar
  2. 2.
    Rowe FJ, Sarkies NJ. The relationship between obesity and idiopathic intracranial hypertension. Int J Obes Relat Metab Disord. 1999;23:54–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Sinclair AJ, Ball AK, et al. Exploring the pathogenesis of IIH; an inflammatory perspective. J Neuroimmunol. 2008;201–202:212–20.CrossRefPubMedGoogle Scholar
  4. 4.
    Hannerz J, Ericson K. The relationship between idiopathic intracranial hypertension and obesity. Headache. 2009;49:178–84.CrossRefPubMedGoogle Scholar
  5. 5.
    Ooi LY, Walker BR, et al. Idiopathic intracranial hypertension: can studies of obesity provide the key to understanding pathogenesis? Br J Neurosurg. 2008;22:187–94.CrossRefPubMedGoogle Scholar
  6. 6.
    Quattrone A, Gambardella A, et al. A hypofibrinolytic state in overweight patients with central venous thrombosis and isolated intracranial hypertension. J Neurol. 1999;246:1086–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Nadkarni T, Rekate HL, Wallace D. Resolution of pseudotumor cerebri after bariatric surgery for related obesity. Case report. J Neurosurg. 2004;101:878–80.CrossRefPubMedGoogle Scholar
  8. 8.
    Sugarman HJ, DeMaria EJ, et al. Increased intra-abdominal pressure and cardiac filling pressures in obesity-related pseudotumor cerebri. Neurology. 1997;49:507–11.Google Scholar
  9. 9.
    Nedelmann M, Kaps M, Mueller-Forell W. Venous obstruction and jugular valve insufficiency in idiopathic intracranial hypertension. J Neurol. 2009;256:964–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Sugarman HJ, Felton III WL, et al. Continuous negative abdominal pressure device to treat pseudotumor cerebri. Int J Obes Relat Metab Disord. 2001;25:486–90.CrossRefGoogle Scholar
  11. 11.
    Wall M. Idiopathic intracranial hypertension (pseudotumor cerebri). Curr Neurol Neurosci Rep. 2008;8:87–92.CrossRefPubMedGoogle Scholar
  12. 12.
    Shin RK, Balcer LJ. Idiopathic intracranial hypertension. Curr Treat Options Neurol. 2002;4:297–305.CrossRefPubMedGoogle Scholar
  13. 13.
    Knight RS, Fielder AR, Firth JL. Benign intracranial hypertension: visual loss and optic nerve sheath fenestration. J Neurol Neurosurg Psychiatry. 1986;49:243–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Kupersmith MJ, Gamell L, et al. Effects of weight loss on the course of idiopathic intracranial hypertension in women. Neurology. 1998;50:1094–8.PubMedGoogle Scholar
  15. 15.
    Wong R, Madill SA, et al. Idiopathic intracranial hypertension: the association between weight loss and the requirement for systemic treatment. BMC Ophthalmol. 2007;7:1–6.CrossRefGoogle Scholar
  16. 16.
    Johnson LN, Krohel GB, et al. The role of weight loss and acetazolamide in the treatment of idiopathic intracranial hypertension (pseudotumor cerebri). Ophthalmology. 1998;105:2313–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Noggle JD, Rodning CB. Rapidly advancing pseudotumor cerebri associated with morbid obesity: an indication for gastric exclusion. South Med J. 1986;79:761–3.CrossRefPubMedGoogle Scholar
  18. 18.
    Amaral J, Tsiaris W, et al. Reversal of benign intracranial hypertension by surgically induced weight loss. Arch Surg. 1987;122:946–9.PubMedGoogle Scholar
  19. 19.
    Sugarman HJ, Felton III WL. Gastric surgery for pseudotumor cerebri associated with severe obesity. Ann Surg. 1999;229:634–42.CrossRefGoogle Scholar
  20. 20.
    Fridley J, Foroozan R, et al. Bariatric surgery for the treatment of idiopathic intracranial hypertension. J Neurosurg. 2010;1–6.Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2010

Authors and Affiliations

  • Richard J. Egan
    • 1
    Email author
  • Hayley E. Meredith
    • 2
  • James E. Coulston
    • 3
  • Luke Bennetto
    • 4
  • Justin D. T. Morgan
    • 1
  • Sally A. Norton
    • 1
  1. 1.Department of General & Bariatric SurgerySouthmead HospitalBristolUK
  2. 2.Bristol Institute of Bariatric SurgerySouthmead HospitalBristolUK
  3. 3.Department of General & Bariatric SurgerySouthmead HospitalBristolUK
  4. 4.Department of NeurosciencesFrenchay HospitalBristolUK

Personalised recommendations