Bariatric surgery as a treatment for idiopathic intracranial hypertension: a systematic review

Handley, Joel; Baruah, Bedanta Prakash; Williams, David M.; Horner, Matthew; Barry, Jonathan; Stephens, Jeffrey W.

doi:10.1016/j.soard.2015.08.497

Cited by 66 publications

(33 citation statements)

References 30 publications

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“…As such we explicitly advocate that IIH should be considered as a co-morbidity of obesity that should be added to the criteria for bariatric surgery worldwide (it is principally listed only in clinical practice guidelines in the USA for patients with IIH and BMI > =35 kg/m 2 [15]).…”

Section: Discussionmentioning

confidence: 99%

“…A previous review of 65 patients demonstrated that following bariatric surgery 92% (60/65) had improvement in IIH outcomes [15]. Although there is also evidence suggesting that non-surgical interventions, including a recent multicentre RCT of weight loss vs. weight loss with acetazolamide [16], may improve IIH outcomes via weight reduction and possibly additional mechanisms, there are lack of studies directly comparing these treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

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Bariatric Surgery or Non-surgical Weight Loss for Idiopathic Intracranial Hypertension? A Systematic Review and Comparison of Meta-analyses

Manfield

Efthimiou

et al. 2016

OBES SURG

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BackgroundIdiopathic intracranial hypertension (IIH) is associated with obesity and weight loss by any means is considered beneficial in this condition.ObjectivesThis study aims to appraise bariatric surgery vs. non-surgical weight-loss (medical, behavioural and lifestyle) interventions in IIH management.MethodsA systematic review and meta-analyses of surgical and non-surgical studies.ResultsBariatric surgery achieved 100% papilloedema resolution and a reduction in headache symptoms in 90.2%. Non-surgical methods offered improvement in papilloedema in 66.7%, visual field defects in 75.4% and headache symptoms in 23.2%. Surgical BMI decrease was 17.5 vs. 4.2 for non-surgical methods.ConclusionsWhilst both bariatric surgery and non-surgical weight loss offer significant beneficial effects on IIH symptomatology, future studies should address the lack of prospective and randomised trials to establish the optimal role for these interventions.Electronic supplementary materialThe online version of this article (doi:10.1007/s11695-016-2467-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bariatric Surgery or Non-surgical Weight Loss for Idiopathic Intracranial Hypertension? A Systematic Review and Comparison of Meta-analyses

Manfield

Efthimiou

et al. 2016

OBES SURG

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“…In recent years, this phenomenon has been objectively demonstrated in an elegant series of animal and human experiments . Additionally, cohort studies of patients undergoing gastric bypass have demonstrated normalization of ICPs with diminishing abdominal girth . Opponents of this theory note IIH can rarely arise in nonobese patients (typically men/adolescents).…”

Section: Pathophysiologymentioning

confidence: 99%

“…Weight‐reduction surgery is considered for patients unable to achieve sufficient loss via diet and lifestyle changes alone . The type of procedure performed does not appear to significantly affect outcomes as long as losses are durable.…”

Section: Conservative Treatment Measuresmentioning

confidence: 99%

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Idiopathic intracranial hypertension: Contemporary review and implications for the otolaryngologist

et al. 2017

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Objectives: 1) Review controversies pertaining to the pathophysiology, diagnosis, and treatment of idiopathic intracranial hypertension. 2) Discuss the evolving role of otolaryngologists in managing this disease and related disorders.Data Sources: Primary literature review, Centers for Disease Control and Prevention website, International Classification of Headache Disorders, Second Edition.Methods: A comprehensive review of the primary literature was performed from 1990 to 2016 utilizing keywords idiopathic intracranial hypertension, pseudotumor cerebri, benign intracranial hypertension, spontaneous cerebrospinal fluid leak, and encephalocele. Articles were included at the discretion of the authors based on novel and/or historical contributions to the literature.Results: The incidence of idiopathic intracranial hypertension is increasing along with the obesity epidemic. Undiagnosed patients may present to otolaryngologists with pulsatile tinnitus, dizziness, sleep apnea, and spontaneous cerebrospinal fluid leaks. Although diagnosis is predicated upon imaging findings and lumbar puncture, radiographic signs including empty sella, optic nerve dilation, and globe flattening may suggest the diagnosis. The most effective intervention is weight loss combined with acetazolamide. Surgery is reserved for severe or refractory symptoms and can be highly morbid. Otolaryngologists are increasingly responsible for managing a number of secondary disorders including cerebrospinal fluid rhinorrhea and otorrhea. Failure to manage intracranial hypertension may lead to adverse surgical outcomes.Conclusions: The knowledge base for idiopathic intracranial hypertension has greatly expanded over the past 25 years. This disease is associated with a number of conditions directly relevant to otolaryngologists. A keen understanding of this disorder and its management may optimize outcomes in a growing number of patients.

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Impact of Obesity and Obstructive Sleep Apnea in Lateral Skull Base Cerebrospinal Fluid Leak Repair

et al. 2019

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ObjectiveTo investigate the prevalence and impact of obstructive sleep apnea (OSA) and obesity in lateral skull base cerebrospinal fluid leak repair (LSBR) of various etiologies.MethodsRetrospective case review at a tertiary skull base center was conducted of consecutive adults undergoing LSBR via transmastoid, middle cranial fossa, or combined approach between 2013–2018. The following data were collected: demographics, comorbidities, radiology and intraoperative findings, and surgical outcomes including complications and need for revision surgery or shunt placement. Patients with incomplete data or leaks following skull base surgery, trauma or chronic ear disease were excluded.ResultsNinety‐four patients (67.4% female, mean age 53.5 ± 12.9 years) underwent repair forspontaneous (sCSFL, 44%) and other etiology (nsCSFL) leaks. nsCSFL served as a comparisongroup consisting of leaks status‐post lateral skull base surgery, temporal bone fractures, andchronic ear disease. Class III obesity (P = .02), OSA (P = .03), and imaging findings of empty sella (OR = 3.32, P = .02), and skull base thinning including contralateral tegmen thinning (31%, OR = 4.3, P = .02), arachnoid granulations (26%, OR = 4.35, P = .02), and superior canal dehiscence (15.8%, OR = 8.57, P = .04) were more common in sCSFL. Four patients (4.2%) required surgical revision for recurrence, and another four (4.2%) resolved with shunting. Evidence of elevated intracranial hypertension was present in nine patients with sCSF leaks and was predictive of need for revision or shunt procedures (P < .01).ConclusionObesity, OSA, and imaging consistent with elevated intracranial pressures were more common among patients with sCSFL. Elevated intracranial pressure predicted outcomes following multilayer repair of spontaneous CSF leaksLevel of Evidence4 Laryngoscope, 130:2234–2240, 2020

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Bariatric surgery as a treatment for idiopathic intracranial hypertension: a systematic review

Cited by 66 publications

References 30 publications

Bariatric Surgery or Non-surgical Weight Loss for Idiopathic Intracranial Hypertension? A Systematic Review and Comparison of Meta-analyses

Bariatric Surgery or Non-surgical Weight Loss for Idiopathic Intracranial Hypertension? A Systematic Review and Comparison of Meta-analyses

Idiopathic intracranial hypertension: Contemporary review and implications for the otolaryngologist

Impact of Obesity and Obstructive Sleep Apnea in Lateral Skull Base Cerebrospinal Fluid Leak Repair

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