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Published on: October 15, 2021
Surgical Interventions in Idiopathic Intracranial Hypertension-A Comprehensive Multi-Center Study of Outcome and the
Gabriel Bsteh1,2, Nadja Skadkær Hansen3, Sina Zaic1,2
1Department of Neurology, Medical University of Vienna, Vienna, Austria.
Insights
Surgery for idiopathic intracranial hypertension (IIH) effectively treats acute visual threats. However, surgery for refractory headache alone in IIH patients is not recommended due to poor outcomes.
Area of Science:
- Ophthalmology
- Neurosurgery
- Neurology
Background:
- Idiopathic intracranial hypertension (IIH) management often involves surgery for severe or refractory cases.
- Limited data exist on surgical outcomes, especially concerning indication-specific effects.
Purpose of the Study:
- To evaluate surgical outcomes in patients with IIH.
- To identify predictors of favorable or adverse surgical results based on indications.
Main Methods:
- A retrospective, multi-center study by the Danish-Austrian IIH Consortium (DASH-IIH).
- Included patients with IIH meeting revised Friedman criteria and undergoing surgery with ≥6 months follow-up.
- Assessed visual function, headache improvement, papilledema resolution, and adverse events using multivariable regression.
Main Results:
- Overall, 3.6% of IIH patients required surgery; 36 were included.
- Indications were acute visual deterioration (83.3%) or refractory headache (16.7%).
- Surgery improved vision in 41.7%, resolved papilledema in 89.7%, and improved headache in 30.6%. No visual improvement occurred for headache-only indications.
Conclusions:
- Cerebrospinal fluid (CSF) diversion and optic nerve sheath fenestration (ONSF) are effective for IIH with acute visual threat.
- These procedures improve vision and, to a lesser extent, headache.
- Refractory headache alone is an insufficient indication for surgical intervention in IIH.
Background:
Surgical intervention is recommended in idiopathic intracranial hypertension (IIH) for fulminant or treatment-refractory cases, yet data on outcomes remain limited, particularly regarding indication-specific effects. This study evaluated outcomes and indications for surgery in IIH, aiming to identify predictors of favorable or adverse results.
Methods:
A retrospective multi-center study was conducted by the Danish-Austrian IIH Consortium (DASH-IIH). Databases from three centers (Vienna, Odense, Copenhagen) were screened for persons with IIH (pwIIH) fulfilling revised Friedman criteria who underwent surgery and had ≥ 6 months of follow-up. Outcomes at 6 months included visual function, headache improvement (≥ 50%), papilledema resolution, and severe adverse events. Multivariable regression was used to adjust for confounders.
Results:
Of 1310 pwIIH, only 3.6% required surgery overall. Thirty-six pwIIH were included (100% female; mean age 32.5 years; median BMI 37.0; median CSF opening pressure 41 cmH2O). Of these, 27 (75%) underwent CSF diversion and 9 (25%) optic nerve sheath fenestration (ONSF). The primary indication for surgery was acute visual deterioration in 83.3% and refractory headache in 16.7%. Visual function improved in 41.7%, papilledema resolved in 89.7%, and headache improved in 30.6%. No significant differences in outcomes were found between CSF diversion and ONSF. Importantly, no visual improvement occurred in cases operated for headache alone, and the odds of headache improvement were significantly lower in this group (OR 0.11, p = 0.012).
Conclusion:
CSF diversion and ONSF are effective in IIH with acute visual threat, improving vision and, to a much lesser extent, headache. Refractory headache alone appears insufficient indication for surgical intervention.
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