The Effects of Laparoscopic Adjustable Gastric Banding on Idiopathic Intracranial Hypertension

Abstract

The purpose of this study was to determine whether laparoscopic adjustable gastric banding has a role in the treatment of idiopathic intracranial hypertension. This pilot study was undertaken in a single, tertiary referral centre. Data on all patients with idiopathic intracranial hypertension that have undergone laparoscopic adjustable gastric banding in our unit were collected from our prospectively maintained bariatric database. Additional information was obtained via telephone questionnaires and review of medical records. Four female patient with a mean age of 32 years (range 29-39 years) and mean pre-operative body mass index of 46.1 kg/m(2) (range 38.2-54.0 kg/m(2)) underwent laparoscopic adjustable gastric banding between June 2006 and July 2009. At a mean follow-up of 19.8 months all four patients reported either total resolution of headache or significant improvement in headache, with a mean improvement in pain score of 76.3/100 (range 55-95) on a analogue pain score. Mean excess weight loss at follow-up was 64.1% (range 50.1-88.2%). There were no complications or mortality in this cohort. This study suggests that laparoscopic adjustable gastric banding represents an effective and safe treatment for idiopathic intracranial hypertension associated with morbid obesity. We have shown good results both in terms of symptom resolution and weight loss, whilst avoiding alimentary tract diversion procedures in these young female patients. A randomized, controlled trial can be justified on the basis of this initial pilot study.

Idiopathic Intracranial Hypertension and Associated Optic Neuropathy in Pediatric Patients

“…Interestingly, in morbidly obese IIH children with unsuccessful trials of weight loss, bariatric surgery can be considered with positive effects. This is also indicated if obesity is associated with other complications other than IIH, such as diabetes or sleep apneas (52,53).…”

Obesity and Headache: Part II – Potential Mechanism and Treatment Considerations

“…When 4 female patients (mean BMI = 46.1) underwent laparoscopic adjustable gastric banding, with subsequent weight loss of 64.1% at follow-up, all 4 patients reported either total resolution or significant improvement in pain score. 59 However, larger randomized studies are not available at this time.…”

“…57,58 Surgical Weight Loss in IIH Patients.-As with migraine, there is some evidence supporting surgical weight loss for treatment of IIH. 59,60 When 19 severely obese women (mean BMI = 47) with IIH underwent bariatric surgery and were followed for 1 year, the mean BMI decreased to 30, and only 1 patient had persistent headache. 60 A more recent small clinical trial also showed promising results.…”

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

“…Four [20–22, 25] of these were non-randomised prospective observation studies, and three [23, 24, 26] were retrospective case series. One study was subsequently excluded from quantitative synthesis due to lack of standard deviation data precluding further analysis.…”