BACKGROUND: Idiopathic intracranial hypertension (IIH) is a disease process attributed to increased intracranial pressure (ICP) that often presents with headaches, visual deterioration, and papilledema. Severe cases are often refractory to medical treatment, lumbar punctures, and cerebrospinal fluid shunts. Internal cranial expansion (ICE) is a relatively novel technique that involves removing and shaving down the skull’s inner calvarial table and cancellous bone to increase intracranial volume and reduce ICP. Previous studies have shown success in pediatric patients. The present study describes the effectiveness of ICE in adult patients with IIH.
METHODS: A retrospective review was conducted of 9 patients from the ages of 18–61 years who underwent ICE for the treatment of IIH. Preoperative and postoperative clinical parameters including patient symptoms, presence of papilledema, and available ICP or cerebrospinal fluid opening pressures were compared. Procedural details and complications were noted. Intracranial volume increases were calculated using available pre- and postoperative computerized tomography scans.
RESULTS: Mean follow-up for the 9 patients in this series was 8 months. Technically successful ICE was performed in all patients within the cohort without any surgical complications. At the time of last follow-up, 4 (44%) of 9 patients were either symptomatically improved or asymptomatic. Three (33%) of 9 patients with headache had a reduction in or complete resolution of this symptom. Papilledema was resolved in all patients (4 of 4) with this sign. Postoperative intracranial volume expansion ranged between 6.9% and 18%.
CONCLUSIONS: ICE is a safe procedure that can provide symptomatic improvement for some adult patients and thus has a role in treatment of refractory IIH outside of the pediatric population. This surgery expands the intracranial volume and thus promotes ICP normalization, which may lead to the reduction or complete resolution of the signs and symptoms of IIH. ICE may be used as part of a multidisciplinary management approach in the treatment of refractory IIH.