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Surgical and endovascular interventions in idiopathic intracranial hypertension

Spitze, Ariellea; Malik, Aminab; Lee, Andrew G.a,c,d,e,f,g

doi: 10.1097/WCO.0000000000000049
NEURO-OPHTHALMOLOGY AND NEUROOTOLOGY: Edited by Adolfo M. Bronstein and Gordon T. Plant

Purpose of review 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.

Recent findings 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.

Summary 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:

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