Update on the surgical management of idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) is a disorder of elevated intracranial pressure due to an unknown cause. In most cases, IIH can be managed with medical therapy and weight reduction. Surgical treatment of IIH is reserved for patients who cannot tolerate medical therapy, are nonadherent to medical therapy, develop progressive symptoms despite maximal medical therapy, or present with fulminant visual loss. To date, there has been no randomized controlled trial to evaluate the surgical treatment of IIH, and our current knowledge of the efficacy and complications of these procedures is based on retrospective and observational studies. This review discusses the indications for surgical intervention in IIH and provides an overview of the recently published data on the efficacy and complications of these interventions. A surgical management algorithm is also presented to guide the clinician when evaluating a patient with IIH.