Interventions for idiopathic intracranial hypertension

Piper, Rory J; Kalyvas, Aristotelis; Young, Adam M. H.; Hughes, Mark; Jamjoom, Aimun A B; Fouyas, Ioannis

doi:10.1002/14651858.cd003434.pub3

Cited by 91 publications

(99 citation statements)

References 57 publications

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“…The first case of IIH, then termed serous meningitis, was probably reported in the 1890s by Henrich Quincke, a German physician, when lumbar puncture (LP) was first introduced. Nonne11 12described a series of cases, similar to Dandy,13 of raised ICP without tumour termed pseudotumour cerebri. Both series contained cases that we now recognise as raised ICP secondary to a known aetiology.…”

Section: Terminologymentioning

confidence: 99%

Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management

Mollan

Ali

Hassan-Smith

et al. 2016

J Neurol Neurosurg Psychiatry

188

162

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Idiopathic intracranial hypertension (IIH) is a rare but important disease associated with significant morbidity. There is an expected rise in prevalence in line with the escalating global burden of obesity. Modern revisions in the terminology and diagnostic criteria for IIH help guide clinicians in investigations and researchers in standardising recruitment criteria for clinical trials. The pathophysiology of IIH is incompletely characterised; suggested underpinning mechanisms include the role of cerebrospinal fluid regulation as well as metabolic and endocrinological perspectives. Recent treatment trials are providing insights into the management but debate still surrounds key areas in treatment. This review will provide an up-to-date discussion on the potential pathogenic mechanisms and management of IIH.

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Section: Terminologymentioning

confidence: 99%

Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management

Mollan

Ali

Hassan-Smith

et al. 2016

J Neurol Neurosurg Psychiatry

188

162

View full text Add to dashboard Cite

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“…There are several surgical options available including optic nerve sheath fenestration, venous stenting and CSF diversion [8,9,10,11]. Because of the usually small size of the ventricles and the resulting difficulty in targeting for placement of the proximal catheter, lumboperitoneal shunting had been favored by many investigators for CSF diversion in IIH for decades.…”

Section: Introductionmentioning

confidence: 99%

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Hermann¹,

Polemikos²,

Heissler³

et al. 2017

Stereotact Funct Neurosurg

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Background: Idiopathic intracranial hypertension (IIH) is characterized by increased cerebrospinal fluid (CSF) pressure and normal or slit ventricles. Lumboperitoneal shunting had been favored by many investigators for CSF diversion in IIH for decades; however, it has been associated with various side effects. Because of the small ventricular size adequate positioning of a ventricular catheter is challenging. Objectives: Here, we investigated the usefulness of electromagnetic (EM)-guided ventricular catheter placement for ventriculoperitoneal shunting in IIH. Methods: Eighteen patients with IIH were included in this study. The age of patients ranged from 5 to 58 years at the time of surgery (mean age: 31.8 years; median: 29 years). There were 2 children (5 and 11 years old) and 16 adults. Inclusion criteria for the study were an established clinical diagnosis of IIH, lack of improvement with medication, and the presence of small ventricles. In all patients EM-navigated placement of the ventricular catheter was performed using real-time tracking of the catheter tip for exact positioning close to the foramen of Monro. Postoperative CT scans were correlated with intraoperative screen shots to validate the position of the catheter. Results: In all patients EM-navigated ventricular catheter placement was achieved with a single pass. There were no intraoperative or postoperative complications. Postoperative imaging confirmed satisfactory positioning of the ventricular catheter. No proximal shunt failure was observed during the follow-up at a mean of 41.5 months (range: 7-90 months, median: 40.5 months). Conclusions: EM-navigated ventricular catheter placement in shunting for IIH is a safe and straightforward technique. It obviates the need for sharp head fixation, the head of the patient can be moved during surgery, and it may reduce the revision rate during follow-up.

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“…9,22 The treatment options in IIH are repeated lumbar tapping, weight reduction, acetazolamide, and surgical diversion of the CSF (that is, shunt surgery) or optic nerve sheath fenestration. 8,36 The pathophysiological mechanisms behind CMI and IIH are still poorly understood, and current treatment strategies are rather empirical, not addressing the primary cause of the disease, which in many cases can result in treatment failure. 7,13,19,31,45 Even though CMI and IIH differ with regard to clinical presentation, radiological findings, and treatment, common underlying mechanisms have been proposed 6 based on observations that both CMI and IIH occur frequently in young, often obese women; 9,24 that the 2 entities share similar symptoms; 19 and, most importantly, that some IIH patients present with radiological evidence of tonsillar ectopy.…”

mentioning

confidence: 99%

Comparative observational study on the clinical presentation, intracranial volume measurements, and intracranial pressure scores in patients with either Chiari malformation Type I or idiopathic intracranial hypertension

Frič

Eide

2017

JNS

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OBJECTIVE Several lines of evidence suggest common pathophysiological mechanisms in Chiari malformation Type I (CMI) and idiopathic intracranial hypertension (IIH). It has been hypothesized that tonsillar ectopy, a typical finding in CMI, is the result of elevated intracranial pressure (ICP) combined with a developmentally small posterior cranial fossa (PCF). To explore this hypothesis, the authors specifically investigated whether ICP is comparable in CMI and IIH and whether intracranial volumes (ICVs) are different in patients with CMI and IIH, which could explain the tonsillar ectopy in CMI. The authors also examined whether the symptom profile is comparable in these 2 patient groups. METHODS The authors identified all CMI and IIH patients who had undergone overnight diagnostic ICP monitoring during the period from 2002 to 2014 and reviewed their clinical records and radiological examinations. Ventricular CSF volume (VV), PCF volume (PCFV), and total ICV were calculated from initial MRI studies by using volumetric software. The static and pulsatile ICP scores during overnight monitoring were analyzed. Furthermore, the authors included a reference (REF) group consisting of patients who had undergone ICP monitoring due to suspected idiopathic normal-pressure hydrocephalus or chronic daily headache and showed normal pressure values. RESULTS Sixty-six patients with CMI and 41 with IIH were identified, with comparable demographics noted in both groups. The occurrence of some symptoms (headache, nausea, and/or vomiting) was comparable between the cohorts. Dizziness and gait ataxia were significantly more common in patients with CMI, whereas visual symptoms, diplopia, and tinnitus were significantly more frequent in patients with IIH. The cranial volume measurements (VV, PCFV, and ICV) of the CMI and IIH patients were similar. Notably, 7.3% of the IIH patients had tonsillar descent qualifying for diagnosis of CMI (that is, > 5 mm). The extent of tonsillar ectopy was significantly different between the CMI and IIH cohorts (p < 0.001) but also between these 2 cohorts and the REF group. Pulsatile ICP was elevated in both cohorts without any significant between-group differences; however, static ICP was significantly higher (p < 0.001) in the IIH group. CONCLUSIONS This study showed comparable and elevated pulsatile ICP, indicative of impaired intracranial compliance, in both CMI and IIH cohorts, while static ICP was higher in the IIH cohort. The data did not support the hypothesis that reduced PCFV combined with increased ICP causes tonsillar ectopy in CMI. Even though impaired intracranial compliance seems to be a common pathophysiological mechanism behind both conditions, the mechanisms explaining the different clinical and radiological presentations of CMI and IIH remain undefined.

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Interventions for idiopathic intracranial hypertension

Abstract: Editorial group: Cochrane Eyes and Vision Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 8, 2015.

Cited by 91 publications

References 57 publications

Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management

Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Comparative observational study on the clinical presentation, intracranial volume measurements, and intracranial pressure scores in patients with either Chiari malformation Type I or idiopathic intracranial hypertension

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