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Acta Neurochirurgica
Published in: Acta Neurochirurgica 1/2017

01-01-2017 | Review Article - Neurosurgical Techniques

Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature

Authors: Aristotelis V. Kalyvas, Mark Hughes, Christos Koutsarnakis, Demetrios Moris, Faidon Liakos, Damianos E. Sakas, George Stranjalis, Ioannis Fouyas

Published in: Acta Neurochirurgica | Issue 1/2017

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Abstract

Background

To define the efficacy, complication profile and cost of surgical options for treating idiopathic intracranial hypertension (IIH) with respect to the following endpoints: vision and headache improvement, normal CSF pressure restoration, papilloedema resolution, relapse rate, operative complications, cost of intervention and quality of life.

Methods

A systematic review of the surgical treatment of IIH was carried out. Cochrane Library, MEDLINE and EMBASE databases were systematically searched from 1985 to 2014 to identify all relevant manuscripts written in English. Additional studies were identified by searching the references of retrieved papers and relative narrative reviews.

Results

Forty-one (41) studies were included (36 case series and 5 case reports), totalling 728 patients. Three hundred forty-one patients were treated with optic nerve sheath fenestration (ONSF), 128 patients with lumboperitoneal shunting (LPS), 72 patients with ventriculoperitoneal shunting (VPS), 155 patients with venous sinus stenting and 32 patients with bariatric surgery. ONSF showed considerable efficacy in vision improvement, while CSF shunting had a superior headache response. Venous sinus stenting demonstrated satisfactory results in both vision and headache improvement along with the best complication profile and low relapse rate, but longer follow-up periods are needed. The complication rate of bariatric surgery was high when compared to other interventions and visual outcomes have not been reported adequately. ONSF had the lowest cost.

Conclusions

No surgical modality proved to be clearly superior to any other in IIH management. However, in certain contexts, a given approach appears more justified. Therefore, a treatment algorithm has been formulated, based on the extracted evidence of this review. The traditional treatment paradigm may need to be re-examined with sinus stenting as a first-line treatment modality.
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Metadata
Title
Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature
Authors
Aristotelis V. Kalyvas
Mark Hughes
Christos Koutsarnakis
Demetrios Moris
Faidon Liakos
Damianos E. Sakas
George Stranjalis
Ioannis Fouyas
Publication date
01-01-2017
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 1/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-016-3010-2

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