A systematic review of surgical treatments of idiopathic intracranial hypertension (IIH)

Kalyvas, Aristotelis; Neromyliotis, Eleftherios; Koutsarnakis, Christos; Komaitis, Spyridon; Drosos, Evangelos; Skandalakis, Georgios P.; Pantazi, Mantha; Gobin, Y. Pierre; Stranjalis, George; Patsalides, Athos

doi:10.1007/s10143-020-01288-1

Cited by 83 publications

(83 citation statements)

References 141 publications

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“…Should surgery be delayed, a lumbar drain can be inserted to protect vision in the intervening period [1]. A large systematic review of 109 studies over a 34-year period showed that CSF diversion procedures for IIH reduced papilloedema in 78.9% of cases and prevented visual field deterioration in 66.8% [71]. The disadvantages of shunts are that they are invasive, carry an infection risk and may require revisions in up to one-third of patients [72].…”

Section: Management Of Fulminant Iihmentioning

confidence: 99%

Reviewing the Recent Developments in Idiopathic Intracranial Hypertension

et al. 2020

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There is increasing evidence and appreciation of idiopathic intracranial hypertension (IIH) in medicine. The pathological processes underlying raised intracranial pressure are being studied, with new insights found in both hormonal dysregulation and the metabolic neuroendocrine axis. These will potentially lead to novel therapeutic targets for IIH. The first consensus guidelines have been published on the investigation and management of adult IIH, and the International Headache Society criteria for headache attributable to IIH have been modified to reflect our evolving understanding of IIH. Randomized clinical trials have been published, and a number of studies in this disease area are ongoing.

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Section: Management Of Fulminant Iihmentioning

confidence: 99%

Reviewing the Recent Developments in Idiopathic Intracranial Hypertension

et al. 2020

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“…This link suggests that controlling increased ICP may improve the results of spontaneous CSF leaks repair and reduce recurrence rates. 7 However, there is significant discrepancy -a form of an "academic disconnect"-between the otolaryngology, neurosurgical, 1 and neurology literature regarding the management of spontaneous CSF leaks [11][12][13] . A significant number of otolaryngologists and neurosurgeons do not acknowledge the link to IIH, [14][15][16][17][18] hence missing the change of diagnosing and treating IIH early.…”

mentioning

confidence: 99%

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

Georgalas

Oostra

Ahmed

et al. 2020

Int Forum Allergy Rhinol

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Background The association between spontaneous cerebrospinal fluid CSF leak/rhinorrhea and idiopathic intracranial hypertension IIH has been increasingly recognized over the last years However considerable variability of opinion regarding the assessment investigations and management of patients with spontaneous CSF rhinorrhea remains Methods A consensus group was formed from experts from Europe Asia Australia South and North America Following literature review and open discussions with members of the panel a set of statements was produced A modified Delphi method was used to refine expert opinion with rounds of questionnaires and a consensus group meeting in Santo-Rhino meeting in September Results Fi y statements of total on spontaneous CSF leak and IIH reached consensus In of statements the median response was strongly agree and in the remaining statements the median response was agree Eleven statements were excluded because they did not reach consensus and one new statement was added during SantoRhino meeting The final statements refer to patient history and clinical examination "History taking should include presence of headache tinnitus and visual defects" investigations role of Thin Slice Computed Tomography and CISS/FLAIR sequences in Magnetic Resonance Imaging principles of management watchful waiting or measures to reduce ICP are supplementary but cannot subsitute surgical closure surgical technique intraoperative early postoperative and long term management Conclusion We present fi y consensus statements on the diagnosis investigation and management of spontaneous CSF rhinorrhea based on the currently available evidence and expert opinion Although by no means comprehensive and final we believe they can contribute to the standardization of clinical practice Early diagnosis prompt surgical closure of the defect assesment for and treatment of potentially co-existing idiopathic intracranial hypertension in a comprehensive multidisciplinary approach are essential in order to successfully manage spontaneous CSF rhinorrhea reduce associated morbidity and prevent recurrence

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“…It was noted that CSF diversion techniques diminished papilledema, visual field deterioration, and headaches in 79%, 67%, and 70% of the cases, respectively, and were associated with a 9% severe complication rate and a 43% failure rate. In contrast, ONS fenestration ameliorated papilledema, visual field defects, and headaches in 90%, 65%, and 49% of patients, respectively, and the severe complication rate was 2%, and the failure rate was 9% [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Bilateral Optic Nerve Decompression for Treatment of Idiopathic Intracranial Hypertension

et al. 2021

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Objective: To evaluate the results of bilateral endoscopic optic nerve decompression (EOND) with the opening nerve sheath (ONS) technique in patients with idiopathic intracranial hypertension (IIH). Methods: Between the years of 2017 and 2019, we retrospectively evaluated nine IIH patients with progressive visual impairment despite medical treatment and who were treated with the EOND and ONS techniques. We also demonstrated our surgical technique recipe on postmortem human heads in a stepwise manner. Results: There were 9 patients (7 females and 2 males) between the ages of 21 and 72 included in this study, and the mean age was 40.8. All patients had an impairment in visual acuity and/or their visual field, with signs of papilledema and/or optic atrophy. The patients were followed up with for 9–48 months. Improvements in visual acuity were observed in 7 out of 9 patients (78%). Visual field defects improved in 5 out of 8 patients (62.5%). Papilledema was resolved in all patients (100%). Headaches improved in all symptomatic patients (100%). No intraoperative or postoperative complications were observed. Conclusions: EOND is a safe and effective surgical procedure in selected patients with IIH. Bilateral wide bony decompression and nerve fenestration can also be an additional benefit for headache relief. Further clinical series and long-term follow-up are needed for more precise results.

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A systematic review of surgical treatments of idiopathic intracranial hypertension (IIH)

Cited by 83 publications

References 141 publications

Reviewing the Recent Developments in Idiopathic Intracranial Hypertension

Reviewing the Recent Developments in Idiopathic Intracranial Hypertension

International Consensus Statement: Spontaneous Cerebrospinal Fluid Rhinorrhea

Endoscopic Bilateral Optic Nerve Decompression for Treatment of Idiopathic Intracranial Hypertension

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