An Update on Idiopathic Intracranial Hypertension and Bariatric Surgery: A Systematic Review

Warren Sun¹, Noah J Switzer², Taylor Smart², Jerry T Dang², Richdeep S Gill², Christopher de Gara², Daniel Birch², Shahzeer Karmali². ¹Faculty of Medicine and Dentistry, University of Alberta, ²University of Alberta

Introduction: We aimed to systematically review the literature to determine the efficacy of bariatric surgery on Idiopathic Intracranial Hypertension (IIH). Commonly referred to as pseudotumour cerebri, the syndrome involves increased intracranial pressures with normal cerebral anatomy, with a constellation of classic symptoms including headache, nausea, visual acuity deficits, pulsatile tinnitus and papilloedema. The link between IIH and obesity has been well established in the literature, likely through transmitted intra-abdominal pressure to the craniospinal axis. As bariatric surgery remains the only proven treatment modality for obesity, case reports and case series have pointed to the potential benefit of this type of intervention for IIH.

Methods and Procedures: A comprehensive search (limited to English and human) of MEDLINE, EMBASE, SCOPUS, the Cochrane Library, and Web of Science from 1946 to July 2015 was completed. Title searching was restricted to the following keywords/terms: bariatric surgery/gastric bypass/ gastric band/ sleeve gastrectomy and intracranial hypertension/pseudotumour cerebri. 120 studies were reviewed for inclusion into the systematic review.

Results: Twelve primary studies (n=39) were included in the systematic review. All patients had a preoperative diagnosis of IIH. Preoperative BMI was 48.55 kg/m2 which improved to 33.67 kg/m2 and 33.94 kg/m2 at 6 and 12 months respectively. Lumbar puncture opening pressures dropping from 403 mmHg pre-operatively to 140 mmHg. Common symptoms of IIH were compared before and after bariatric surgery respectively: headaches (100% vs 10%), visual complaints (62% vs 44%), tinnitus (56% vs 3%), papilloedema (62% vs 8%).

Conclusion: Bariatric surgery appears to lead to marked improvement in IIH. IIH is not a well publicized comorbidity of obesity but its presence should be considered as an indication for surgical intervention.