Surgical Management of Idiopathic Intracranial Hypertension in Pregnancy

Surgical Management of Idiopathic Intracranial Hypertension in Pregnancy: Response

“…1 Many providers prefer to avoid acetazolamide especially during the first 20 weeks of gestation because of the category C classification of the drug as a possible teratogen. 2 We acknowledge, however, that there are limited data on possible teratogenicity in humans for acetazolamide, and we agree with Tyndel et al that a multidisciplinary approach, including individual risk-benefit analysis, is appropriate for fulminant disease in general but especially in pregnancy.…”

“…2 The choice of surgical procedure in IIH, including fulminant disease, is often dictated by the availability of local surgical expertise for a specific procedure (e.g., optic nerve sheath fenestration, venous sinus stenting, and cerebrospinal fluid shunt). 1,2…”

“…We agree that aggressive treatment is warranted for acute and severe (i.e., fulminant) IIH, and the most important (but often underrecognized) temporizing approach is the placement of a lumbar drain until definitive surgery can be performed. 2 The choice of surgical procedure in IIH, including fulminant disease, is often dictated by the availability of local surgical expertise for a specific procedure (e.g., optic nerve sheath fenestration, venous sinus stenting, and cerebrospinal fluid shunt). 1,2…”

Comments on: Surgical Management of Idiopathic Intracranial Hypertension in Pregnancy

“…Since the time of that review, we have reported the case of a patient with fulminant IIH in pregnancy who was treated surgically with good outcome. 2 As suggested by Karimaghaei et al, 1 our patient required multidisciplinary coordination of her care, and we wish to draw readers' attention to the added challenge posed by the fulminant presentation during pregnancy.…”

“…In their excellent article, Karimaghaei et al 1 provide a table of patients reported in the literature (up to August 2021) who had undergone surgery for idiopathic intracranial hypertension (IIH) during pregnancy.…”