Bariatric surgery for the treatment of idiopathic intracranial hypertension

Fridley, Jared; Foroozan, Rod; Sherman, Vadim; Brandt, Mary L.; Yoshor, Daniel

doi:10.3171/2009.12.jns09953

Cited by 126 publications

(76 citation statements)

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“…There is robust evidence for an association between obesity and idiopathic intracranial hypertension (pseudotumor cerebri). 13,17,30,31 Just as obesity has been linked to elevated ICP, at least in some cases, there have also been several reports that have linked elevated ICP with CM-I. 2,7 It is probable that symptoms of CM and the formation of spinal syrinxes are the result of crowding at the foramen magnum, which results in abnormal cerebrospinal fluid flow at the craniocervical junction.…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index on cerebellar tonsil position in healthy subjects and patients with Chiari malformation

Smith¹,

Strahle²,

Kazarian³

et al. 2015

JNS

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OBJECT It is unclear if there is a relationship between Chiari malformation Type I (CM-I) and body mass index (BMI). The aim of this study was to identify the relationship between BMI and cerebellar tonsil position in a random sample of people. METHODS Cerebellar tonsil position in 2400 subjects from a cohort of patients undergoing MRI was measured. Three hundred patients were randomly selected from each of 8 age groups (from 0 to 80 years). A subject was then excluded if he or she had a posterior fossa mass or previous posterior fossa decompression or if height and weight information within 1 year of MRI was not recorded in the electronic medical record. RESULTS There were 1310 subjects (54.6%) with BMI records from within 1 year of the measured scan. Of these subjects, 534 (40.8%) were male and 776 (59.2%) were female. The average BMI of the group was 26.4 kg/m2, and the average tonsil position was 0.87 mm above the level of the foramen magnum. There were 46 subjects (3.5%) with a tonsil position ≥ 5 mm below the level of the foramen magnum. In the group as a whole, there was no correlation (R2 = 0.004) between BMI and cerebellar tonsil position. CONCLUSIONS In this examination of 1310 subjects undergoing MRI for any reason, there was no relationship between BMI and the level of the cerebellar tonsils or the diagnosis of CM-I on imaging.

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Section: Discussionmentioning

confidence: 99%

Impact of body mass index on cerebellar tonsil position in healthy subjects and patients with Chiari malformation

Smith¹,

Strahle²,

Kazarian³

et al. 2015

JNS

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“…The systematic review conducted by Fridley et al 13 identi- However, these authors also emphasized that there was a higher degree of morbidity in the bariatric surgery group, compared with the other treatment regimens evaluated in other studies.…”

Section: Case Reportmentioning

confidence: 98%

Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature

et al. 2017

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CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of childbearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH 2 O. She presented a body mass index of 39.5 kg/m 2 , also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH 2 O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm. RESUMOCONTEXTO: O pseudotumor cerebri ocorre quando há aumento na pressão intracraniana sem causa subjacente, comumente levando a perda visual. É mais comum em mulheres obesas em idade fértil. RELATO DE CASO: Mulher de 46 anos, foi admitida com hipertensão intracraniana idiopática diagnosticada há dois anos, que levou a cefaleia refratária crônica e perda estimada de 30% da acuidade visual, associada a papiledema bilateral. Apresentou melhora parcial da cefaleia com acetazolamida, mas a perda visual persistiu. A pressão intracraniana era de 34 cmH 2 O. Apresentava índice de massa corpórea de 39,5 kg/m 2 , associado a hipertensão arterial. Tomografia computadorizada com contraste endovenoso de crânio não apresentou anormalidades. Foi submetida ao bypass gástrico em Y de Roux, com evolução pós-operatória sem intercorrências. Um mês após a cirurgia, apresentou perda de peso em excesso de 24%. Um exame oftalmológico demonstrou ausência de perda visual e remissão do papiledema; não houve novos episódios de cefaleia após a cirurgia. Houve também resolução completa da hipertensão arterial. A pressão intracraniana caiu para 24 cmH 2 O após seis meses da cirurgia. CONCLUSÃO: Embora a condição seja usualmente associada à obesidade, há escassos relatos de cirurgia bariátrica em indivíduos com pseudotumor cerebri. Nos casos previamente estudados, há alta pre...

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“…4,19,20 There is evidence that bariatric surgery improves benign intracranial hypertension symptomatology, reduces intracranial pressure, and abates CSF rhinorrhoea. 39,40 The revision cases share similarities, namely spontaneous leaks are more difficult to manage and have lower success rates, with these patients typically being obese, middle-aged women with defects in pneumatized sphenoid lateral recesses. 4,19,20,23 Our other three failures belonged to this group and had successful revisions, with two being sphenoid and the other a posterior ethmoid roof defect.…”

Section: Discussionmentioning

confidence: 99%

“…22 These include conservative (diet and weight loss), medical (loop diuretics and carbonic anhydrase inhibitors), radiological (intracranial venous shunting), and surgical (ventriculoperitoneal shunting or bariatric surgery) options. 4,19,20,[39][40][41][42][43][44] Complications included three postoperative episodes of transient pyrexia 24 hours postoperatively with negative blood cultures and no meningitis. In follow-up, two patients complained of hyposmia, two patients developed persistent atypical facial pain managed by neurologists, and two patients presented with intranasal synechiae, one of whom required surgical division.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Cerebrospinal Fluid Rhinorrhea: The Charing Cross Experience

Virk¹,

Elmiyeh²,

Saleh³

2012

J Neurol Surg B

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Bariatric surgery for the treatment of idiopathic intracranial hypertension

Abstract: The published Class IV evidence suggests that bariatric surgery may be an effective treatment for IIH in obese patients, both in terms of symptom resolution and visual outcome. Prospective, controlled studies are necessary for better elucidation of its role.

Cited by 126 publications

References 50 publications

Impact of body mass index on cerebellar tonsil position in healthy subjects and patients with Chiari malformation

Impact of body mass index on cerebellar tonsil position in healthy subjects and patients with Chiari malformation

Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature

Endoscopic Management of Cerebrospinal Fluid Rhinorrhea: The Charing Cross Experience

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