TY - JOUR
TI - A systematic review of surgical treatments of idiopathic intracranial hypertension (IIH)
AU - Kalyvas, A.
AU - Neromyliotis, E.
AU - Koutsarnakis, C.
AU - Komaitis, S.
AU - Drosos, E.
AU - Skandalakis, G.P.
AU - Pantazi, M.
AU - Gobin, Y.P.
AU - Stranjalis, G.
AU - Patsalides, A.
JO - Neurosurgical Review
PY - 2021
VL - 44
TODO - 2
SP - 773-792
PB - Springer Science and Business Media Deutschland GmbH
SN - 0344-5607, 1437-2320
TODO - 10.1007/s10143-020-01288-1
TODO - anisocoria;  bariatric surgery;  cerebrospinal fluid shunting;  clinical effectiveness;  conjunctival hemorrhage;  convergent strabismus;  diplopia;  fenestration;  headache;  human;  idiopathic intracranial hypertension;  intervention study;  lumbar puncture;  optic nerve disease;  optic nerve sheath fenestration;  orbit disease;  orbital hematoma;  outcome assessment;  papilledema;  phlebography;  postoperative complication;  prospective study;  Review;  shunting;  systematic review;  treatment failure;  treatment outcome;  treatment response;  vein surgery;  venous sinus stenting;  visual acuity;  visual field;  visual field defect;  adult;  brain pseudotumor;  complication;  female;  headache;  male;  neurosurgery;  observational study;  pathophysiology;  physiology;  procedures;  stent;  visual disorder, Adult;  Female;  Headache;  Humans;  Male;  Neurosurgical Procedures;  Observational Studies as Topic;  Prospective Studies;  Pseudotumor Cerebri;  Stents;  Vision Disorders;  Visual Fields
TODO - 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. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
ER -