Trends in the Surgical Treatment of Pseudotumor Cerebri Syndrome in the United States

Hamedani, Ali G.; Thibault, Dylan; Revere, Karen; Lee, John Y.K.; Grady, M. Sean; Willis, Allison W.; Liu, Grant T.

doi:10.1001/jamanetworkopen.2020.29669

Cited by 25 publications

(21 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Surgical treatment for IIH is recommended in medically refractory cases, non-compliance, or in cases with severe and rapid decline in visual function. Neurosurgical cerebrospinal fluid (CSF) diversion is generally considered effective for immediate stabilization of the condition, and shunt treatment is the most common surgical approach in IIH [ 6 , 7 ]. Shunt treatment, however, is susceptible to high failure rates and multiple surgical revisions [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Unilateral Optic Nerve Sheath Fenestration in Idiopathic Intracranial Hypertension: A 6-Month Follow-Up Study on Visual Outcome and Prognostic Markers

Hagen

Wegener

Toft

et al. 2021

Life

View full text Add to dashboard Cite

Loss of vision is a feared consequence of idiopathic intracranial hypertension (IIH). Optic nerve sheath fenestration (ONSF) may be an effective surgical approach to protect visual function in medically refractory IIH. In this study, we evaluate the impact of unilateral superomedial transconjunctival ONSF on bilateral visual outcome using a comprehensive follow-up program. A retrospective chart review of IIH patients who underwent unilateral ONSF between January 2016 and March 2021 was conducted. Patients fulfilling the revised Friedman criteria for IIH and who had exclusively received ONSF as a surgical treatment were included. Main outcomes were visual acuity (VA); perimetric mean deviation (PMD); papilledema grade; and optic nerve head elevation (maxONHE) 1 week, 2 weeks, and 1, 3, and 6 months after surgery. VA (p < 0.05), PMD (p < 0.05), papilledema grade (p < 0.01), and maxOHNE (p < 0.001) were improved after 6 months on both the operated and non-operated eye. Prolonged surgical delay impedes PMD improvement (r = −0.78, p < 0.01), and an increasing opening pressure initiates a greater ganglion cell loss (r = −0.79, p < 0.01). In this small case series, we demonstrate that unilateral superonasal transconjunctival ONSF is a safe procedure with an effect on both eyes. Optic nerve head elevation and PMD are feasible biomarkers for assessing early treatment efficacy after ONSF.

show abstract

Section: Introductionmentioning

confidence: 99%

Unilateral Optic Nerve Sheath Fenestration in Idiopathic Intracranial Hypertension: A 6-Month Follow-Up Study on Visual Outcome and Prognostic Markers

Hagen

Wegener

Toft

et al. 2021

Life

View full text Add to dashboard Cite

show abstract

“…Retrospective chart reviews report favorable outcomes through the modern superior eyelid skin crease approach [ 44 , 45 ]. The English rate of fenestration appears to be a much lower than in the United States, where 1 in 10 surgically treated IIH cases had an optic nerve sheath fenestration, as compared to receiving a shunt [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Intracranial Hypertension: Evaluation of Admissions and Emergency Readmissions through the Hospital Episode Statistic Dataset between 2002–2020

Mollan

Mytton

Tsermoulas

et al. 2021

Life

View full text Add to dashboard Cite

With increasing incidence and prevalence of Idiopathic intracranial hypertension in the UK, the aim of this study was to explore emerging themes in Idiopathic intracranial hypertension using the Hospital Episode Statistics dataset and to quantify recent change in hospital admissions and surgeries performed within England. Methods: Hospital Episode Statistics national data was extracted between 1 April 2002 and 31 March 2019, and followed up until 31 March 2020. All those within England with a diagnosis of Idiopathic Intracranial Hypertension were included. Those with secondary causes of raised intracranial pressure such as tumors, hydrocephalus and cerebral venous sinus thrombosis were excluded. Results: 28,794 new IIH cases were diagnosed between 1 January 2002 and 31 December 2019. Incidence rose between 2002 to 2019 from 1.8 to 5.2 per 100,000 in the general population. Peak incidence occurred in females aged 25–29 years. Neurosurgical shunt was the commonest procedure performed (6.4%), followed by neovascular venous sinus stenting (1%), bariatric surgery (0.8%) and optic nerve sheath fenestration (0.5%). The portion of the total IIH population requiring a shunt fell from 10.8% in 2002/2003 to 2.46% in 2018/2019. The portion of the total IIH population requiring shunt revision also reduced over time from 4.84% in 2002/2003 to 0.44% in 2018/2019. The mean 30 days emergency readmissions for primary shunt, revision of shunt, bariatric surgery, neurovascular stent, and optic nerve sheath fenestration was 23.1%, 23.7%, 10.6%, 10.0% and 9.74%, respectively. There was a peak 30 days readmission rate following primary shunt in 2018/2019 of 41%. Recording of severe visual impairment fell to an all-time low of 1.38% in 2018/19. Conclusions: Increased awareness of the condition, specialist surgery and expert guidance may be changing admissions and surgical trends in IIH. The high 30 readmission following primary shunt surgery for IIH requires further investigation.

show abstract

“…This may reflect the underlying concerns about lack of trial data or limitations in access to orbital surgical expertise. 56 Coexisting conditions in IIH that may influence headache…”

Section: Lumbar Puncturementioning

confidence: 99%

Headache attributed to idiopathic intracranial hypertension and persistent post‐idiopathic intracranial hypertension headache: A narrative review

Mollan

Grech

2021

Headache

View full text Add to dashboard Cite

Objective Headache is a near‐universal sequela of idiopathic intracranial hypertension (IIH). The aim of this paper is to report current knowledge of headache in IIH and to identify therapeutic options. Background Disability in IIH is predominantly driven by headache; thus, headache management is an urgent and unmet clinical need. At present, there is currently no scientific evidence for the directed use of abortive or preventative headache therapy. Methods A detailed search of the scientific literature and narrative review was performed. Results Headache in IIH is driven by raised intracranial pressure (ICP) and reduction of ICP has been reported in some studies to reduce headache. Despite resolution of papilledema and normalization of raised ICP, a majority suffer persistent post‐IIH headache. The lack of evidence‐based management approaches leaves many untreated. Where clinicians attempt to manage IIH headache, they use off‐label therapies to target the prevailing headache phenotype. A recent prospective open‐label study demonstrated the effective use of a calcitonin gene‐related peptide monoclonal antibody therapy in IIH for persistent post‐IIH headache. Conclusions There is overwhelming evidence of the headache burden in IIH. Studies are required to investigate the biological foundations of headache related to ICP and to develop treatments specifically directed to manage headache in IIH.

show abstract

Trends in the Surgical Treatment of Pseudotumor Cerebri Syndrome in the United States

Cited by 25 publications

References 17 publications

Unilateral Optic Nerve Sheath Fenestration in Idiopathic Intracranial Hypertension: A 6-Month Follow-Up Study on Visual Outcome and Prognostic Markers

Unilateral Optic Nerve Sheath Fenestration in Idiopathic Intracranial Hypertension: A 6-Month Follow-Up Study on Visual Outcome and Prognostic Markers

Idiopathic Intracranial Hypertension: Evaluation of Admissions and Emergency Readmissions through the Hospital Episode Statistic Dataset between 2002–2020

Headache attributed to idiopathic intracranial hypertension and persistent post‐idiopathic intracranial hypertension headache: A narrative review

Contact Info

Product

Resources

About