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Updated: Feb 9, 2026
Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
Published on: May 23, 2021
[Current diagnosis and treatment of idiopathic intracranial hypertension]
Bernadett Salomváry1, Gyula Pánczél2, Balázs Markia1
1Országos Klinikai Idegtudományi Intézet, Budapest.
Insights
Early diagnosis and treatment of idiopathic intracranial hypertension prevent vision loss. Ventriculo-peritoneal shunts are effective and safe for severe cases, but timely surgery is crucial for preserving visual function.
Area of Science:
- Neuroscience
- Ophthalmology
- Neurosurgery
Background:
- Idiopathic intracranial hypertension (IIH) causes increased intracranial pressure of unknown origin.
- Untreated IIH can lead to irreversible vision loss.
Purpose of the Study:
- To evaluate the efficacy and safety of ventriculo-peritoneal shunts for IIH.
- To assess the optimal timing for surgical intervention in IIH patients.
Main Methods:
- Retrospective analysis of 65 patients (15 children, 50 adults) with IIH treated between 2009 and 2017.
- Comparison of conservative versus surgical management (ventriculo-peritoneal shunt).
- Analysis of clinical presentation, visual function, and surgical outcomes.
Main Results:
- Surgical intervention was indicated for severe papilledema, deteriorating vision, or treatment-resistant cases.
- Ventriculo-peritoneal shunting led to significant improvement in papilledema and visual field deficits.
- Visual acuity improved post-surgery, particularly in patients with preoperative acuity ≥0.3.
- Complications included shunt revision (17%) and infection (8.5%); no surgical mortality.
- Early diagnosis and treatment are key to preventing persistent visual loss.
Conclusions:
- Idiopathic intracranial hypertension is a treatable condition with appropriate management.
- Timely surgical intervention with ventriculo-peritoneal shunts is effective and safe for preserving visual function.
- Close neuro-ophthalmic monitoring is essential for determining optimal surgical timing and preventing severe visual loss.
Background And Purpose:
Idiopathic intracranial hypertension is cha-racterized by raised intracranial pressure of unknown origin, leading to persisting visual loss if left untreated. Purpose - We assessed timing of surgery, and the efficacy and safety of ventriculo-peritoneal shunt.
Methods:
Retrospective analysis of 65 patients treated at our Neuro-ophthalmology Clinic between 2009 and 2017. Patients - We treated 15 children and 50 adults, 42 patients conservatively, and 23 surgically. The median age at presentation was 27 years for adults, 88% were obese, and 86% female. The age of children was 5-17 years, 40% were obese, and 53% girl. The commonest presentation symptom was headache in both groups (64%), followed by obscuration (33%), and double vision (22-31%). Subjective visual loss was only experienced in the surgical group (50%). The time until diagnosis was 2 weeks in both groups. However, the conservative group presented to our institute significantly earlier (3 weeks), than the surgical group (8 weeks). The follow-up time was 25 months.
Results:
In the conservative group papilla edema was 2D, visual acuity ≥0.7, and visual field loss was only mild. Time to cure was 3 months. In the surgical group both preoperative papilla edema (3D), and visual function were significantly worse. Indications for surgery were papilla edema, deteriorating visual function or relapse resistant to conservative treatment. Papilla edema disappeared 3 months after surgery, and visual field deficit improved significantly. We detected significant improvement in all aspects of visual function even at first neuro-ophthalmic control 4 days after surgery. However, visual acuity only improved in cases of preoperative acuity ≥0.3. Shunt revision occurred in 17%, and shunt infection in 8.5%. One patient suffered from persistent visual deterioration after surgery, and asymptomatic complication (epidural hematoma) was found in another patient. There was no surgical mortality.
Conclusion:
This is a curable condition with early diagnosis and adequate treatment, and persistent visual loss can be prevented. Surgery is effective and safe, close neuro-ophthalmic monitoring is mandatory for its optimal timing. Visual function of all patients can be preserved when operated on in time, whereas severe visual loss appears to be irreversible despite surgery.
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