Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature

Abstract

CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of childbearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH 2 O. She presented a body mass index of 39.5 kg/m 2 , also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH 2 O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm. RESUMOCONTEXTO: O pseudotumor cerebri ocorre quando há aumento na pressão intracraniana sem causa subjacente, comumente levando a perda visual. É mais comum em mulheres obesas em idade fértil. RELATO DE CASO: Mulher de 46 anos, foi admitida com hipertensão intracraniana idiopática diagnosticada há dois anos, que levou a cefaleia refratária crônica e perda estimada de 30% da acuidade visual, associada a papiledema bilateral. Apresentou melhora parcial da cefaleia com acetazolamida, mas a perda visual persistiu. A pressão intracraniana era de 34 cmH 2 O. Apresentava índice de massa corpórea de 39,5 kg/m 2 , associado a hipertensão arterial. Tomografia computadorizada com contraste endovenoso de crânio não apresentou anormalidades. Foi submetida ao bypass gástrico em Y de Roux, com evolução pós-operatória sem intercorrências. Um mês após a cirurgia, apresentou perda de peso em excesso de 24%. Um exame oftalmológico demonstrou ausência de perda visual e remissão do papiledema; não houve novos episódios de cefaleia após a cirurgia. Houve também resolução completa da hipertensão arterial. A pressão intracraniana caiu para 24 cmH 2 O após seis meses da cirurgia. CONCLUSÃO: Embora a condição seja usualmente associada à obesidade, há escassos relatos de cirurgia bariátrica em indivíduos com pseudotumor cerebri. Nos casos previamente estudados, há alta pre...

Bariatric Surgery as a Treatment for Idiopathic Intracranial Hypertension in a Male Adolescent: Case Report

“…14 Other reports also showed the safety of the bariatric surgery as a treatment for IIH. [15][16][17] Laparoscopic sleeve gastrectomy could be an alternative surgery since it has already proven to be safe and effective in the treatment of morbidly obese adolescents. 18 Mortality rates after bariatric surgery are low.…”

Bariatric surgery and its impact on pseudotumor cerebri: A case report

“… 3 However, the current literature consists only of case reports or small retrospective studies that suggest that bariatric surgery is an effective treatment for pseudotumor cerebri. 1 , 4 , 5 The reports in the literature lack substantial data supporting the benefit from weight loss surgery. Most recently, Cazzo et al report a similar case report with improvement in visual loss from their patient after bariatric surgery adding yet another successful outcome to the literature but without objective data to support the visual improvement after bariatric surgery.…”

“…Most recently, Cazzo et al report a similar case report with improvement in visual loss from their patient after bariatric surgery adding yet another successful outcome to the literature but without objective data to support the visual improvement after bariatric surgery. 4 Another review of the literature reports only one case series that monitored the visual fields in their patients and recommend that future studies include more qualitative data such as Snellen visual acuity, Humphrey visual fields, and lumbar puncture opening pressure. 6 , 7 Handley et al also made the observation that many of the small case series and reports in the literature lacked sufficient objective data.…”

Idiopathic Intracranial Hypertension: Current Neuroophthalmologic Points

“…Применение бариатрической хирургии сопровождается разрешением застоя ДЗН (до 100 % случаев) и уменьшением головной боли (в 90,2 % случаев) [59]. За рубежом описаны случаи применения обходного желудочного анастомоза по Ру для снижения веса у пациентов с ИВЧГ [60]. Однако по данным отдельных авторов этот вид хирургического лечения характеризуется высокой частотой осложнений [49].…”