Bariatric Surgery as a Viable Treatment for Idiopathic Intracranial Hypertension: a Case Series and Review of Literature

Abstract

Purpose Idiopathic intracranial hypertension is a significant cause of preventable blindness. Patients suffer from debilitating headaches, pulsatile tinnitus, nausea, vomiting, photophobia and radicular pain. At this rate, treatment cost will increase to 462.7 million pounds sterling annually by 2030. Weight loss is the only proven disease-modifying therapy for reversal of idiopathic intracranial hypertension. Bariatric surgery leads to superlative weight loss and reversal of related comorbidities. The case series and literature review aim to raise awareness of bariatric surgery as a safe and effective treatment modality for idiopathic intracranial hypertension. Material and Methods The literature review comprises three systematic analysis and one randomised control trial which were identified after a PubMed search. In the case series, we have included four patients with a preoperative diagnosis of long-standing idiopathic intracranial hypertension. They were referred to our department for bariatric surgery by the neuro-ophthalmologist between January and December 2018. They were followed up for 2 years after bariatric surgery. Results All four patients were women with a mean age of 34 years. Mean body mass index reduced from 47.3 kg/m 2 before surgery to 30 kg/m 2 at the end of 2 years after surgery. They showed significant improvement or resolution in their symptoms related to idiopathic intracranial hypertension, and none of them required further cerebrospinal fluid pressure reducing procedures. Conclusion Bariatric surgery is a safe and effective method of treating idiopathic intracranial hypertension. It is superior compared to medical management and cerebrospinal fluid pressure reducing procedures which have high rates of recurrence.

Idiopathic Intracranial Hypertension in a Morbidly Obese Young Female Managed With Bariatric Surgery

“…However, these studies were not comparable, and hence their findings cannot be used to directly compare the outcomes of bariatric and non-surgical weight loss interventions [ 10 ]. Another study has presented more accurate results by comparing non-surgical and surgical methods to reduce BMI and improve symptoms of IIH; this well-conducted systematic analysis with a large sample size has convincingly demonstrated the advantage of bariatric surgical interventions compared to non-surgical interventions in managing IIH based on a significant and steady reduction in the patient's BMI following the surgical approach [ 1 ]. However, despite the fact that there is a clear correlation between IIH and obesity, IIH is not generally accepted as an indication for bariatric surgery [ 1 ].…”

“…Another study has presented more accurate results by comparing non-surgical and surgical methods to reduce BMI and improve symptoms of IIH; this well-conducted systematic analysis with a large sample size has convincingly demonstrated the advantage of bariatric surgical interventions compared to non-surgical interventions in managing IIH based on a significant and steady reduction in the patient's BMI following the surgical approach [ 1 ]. However, despite the fact that there is a clear correlation between IIH and obesity, IIH is not generally accepted as an indication for bariatric surgery [ 1 ]. Therefore, these patients will experience longer waiting periods for bariatric surgery, particularly in public health systems in which patients are frequently evaluated depending on their degree of obesity and comorbidity [ 1 ].…”

“…Idiopathic intracranial hypertension (IIH) is a debilitating disease and a significant cause of blindness among patients. Its incidence has increased steadily over the past few years [ 1 ]. It is usually seen in obese women, and patients generally complain of severe headaches, pulsatile tinnitus, nausea, vomiting, photophobia, radicular pain, and progressive loss of vision [ 1 ].…”

“…Its incidence has increased steadily over the past few years [ 1 ]. It is usually seen in obese women, and patients generally complain of severe headaches, pulsatile tinnitus, nausea, vomiting, photophobia, radicular pain, and progressive loss of vision [ 1 ]. Furthermore, obesity is a major risk factor for IIH, and usually, the main symptom of IIH is a headache (84%) manifesting as a daily bilateral, frontal, retro-ocular headache, as well as visual loss presenting as a major morbidity leading to blindness; up to 68% of IIH patients suffer from transient visual disturbances [ 2 ].…”

ENDOCRINE OBESITY: Pituitary dysfunction in obesity

“…Weight loss is an essential part of the treatment for IIH, and it has been demonstrated that weight loss after a low-energy diet or after bariatric surgery is associated with complete remission or considerable improvement in the signs and symptoms associated with IIH (103,104,105,106). A recent randomized clinical trial with 66 women with obesity with IIH demonstrated that bariatric surgery was more effective than community weight management intervention in reducing intracranial pressure because of the greater sustained weight loss (107).…”