Idiopathic intracranial hypertension (IIH) is a potentially blinding disease and may require surgical management when maximal medical treatment has failed. The purpose of this review is to discuss the current literature on surgical and endovascular treatments for IIH.
The most commonly performed surgical treatments for IIH are cerebrospinal fluid diversion procedures (e.g. ventriculo- and lumbo-peritoneal shunts) and optic nerve sheath fenestration. Controversy still exists about which is the preferred initial surgical treatment for IIH. Emerging procedures include venous sinus stenting in cases with venous sinus stenosis, and bariatric surgery for weight loss. Cranial (suboccipital or subtemporal) decompression was a more popular surgical procedure in the past, but can still have a role in selected cases with impaired cerebrospinal flow dynamics (e.g. Chiari malformation) or after multiple failed conventional surgical procedures.
This review compares and contrasts the surgical management options for IIH.
aDepartment of Ophthalmology, Houston Methodist Hospital, Houston, Texas
bDepartment of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio
cDepartments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, Texas
dDepartment of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
eDepartment of Ophthalmology, Baylor College of Medicine, Houston
fDepartment of Ophthalmology, The University of Texas Medical Branch, Galveston
gUT MD Anderson Cancer Center, Houston, Texas, USA.
Correspondence to Andrew G. Lee, MD, Department of Ophthalmology, Houston Methodist Hospital, 6560 Fannin Street, Scurlock Tower 450, Houston, TX 77030, USA. Tel: +1 713 441 8823; fax: +1 713 793 1636; e-mail: AGLee@HoustonMethodist.org