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

  • Review Article - Neurosurgical Techniques
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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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Abbreviations

BMI:

Body mass index

CSF:

Cerebrospinal fluid

HDU:

High dependency unit

HRQOL:

Health-related quality of life

ICP:

Intracranial pressure

IIH:

Idiopathic intracranial hypertension

LAGB:

Laparoscopic adjustable gastric banding

LOS:

Length of hospital stay

LPS:

Lumboperitoneal shunting

LRYGB:

Laparoscopic Roux-en-Y gastric bypass

MRI:

Magnetic resonance imaging

MRV:

Magnetic resonance venography

NHS:

National health service

ONSF:

Optic nerve sheath fenestration

PICOS:

Participants, Interventions, Comparisons, Outcomes, Studies

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RCT:

Randomised control trial

RPPR:

Revision per patient rate

SVPS:

Stereotactic ventriculoperitoneal shunting

VPS:

Ventriculoperitoneal shunting

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Authors and Affiliations

  1. University of Edinburgh, Edinburgh, UK

    Aristotelis V. Kalyvas, Mark Hughes & Ioannis Fouyas

  2. Department of Neurosurgery, University of Athens, Evangelismos Hospital, Ipsilantou 45-47, 10676, Athens, Greece

    Aristotelis V. Kalyvas, Faidon Liakos, Damianos E. Sakas & George Stranjalis

  3. Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK

    Mark Hughes, Christos Koutsarnakis & Ioannis Fouyas

  4. Hellenic Center for Neurosurgical Research “Prof. Petros Kokkalis”, Athens, Greece

    Christos Koutsarnakis, Faidon Liakos & George Stranjalis

  5. Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Demetrios Moris

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Comments

Kalyvas and co-workers provide a systematic review of the literature about “Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension”. I have read the paper with great interest and congratulate the authors for this—in my opinion—important review. The limitation of difficulties in comparing lengths of hospital stay, hardware costs and operative time costs in different hospitals and even more in different countries has been adequately discussed.

Marcus Reinges

Giessen, Germany

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Kalyvas, A.V., Hughes, M., Koutsarnakis, C. et al. Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature. Acta Neurochir 159, 33–49 (2017). https://doi.org/10.1007/s00701-016-3010-2

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