Laparoscopic sleeve gastrectomy for the treatment of idiopathic intracranial hypertension in patients with severe obesity.

Abstract

Severe obesity is a major risk factor for idiopathic intracranial hypertension (IIH). Data on the role of bariatric surgery for the treatment of this condition are scarce. To evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) on treating IIH in severely obese patients. Two university bariatric surgery centers. Prospectively collected data from consecutive patients undergoing LSG were retrospectively analyzed. Patients with IIH and referred by neuroophthalmologists for bariatric surgery were included in the analysis. Fifteen female patients with IIH underwent LSG (median age: 31 yr). Median preoperative body mass index was 42.1 kg/m2. Preoperatively, 14 patients (93.3%) had chronic headaches, 8 (53.3%) pulsatile tinnitus, and 1 (6.6%) epistaxis episodes. Ophthalmologic assessment showed bilateral papilledema in all patients, of whom 13 had visual symptoms. Median initial cerebrospinal fluid opening pressure was 31 cmH2 O (range: 25-50 cmH2 O); 4 patients required repeated decompressing lumbar punctures (1 ventriculoperitoneal shunt). LSG was successfully performed in all patients. No patients were lost to follow-up. Mean excess weight loss was and 87.4% and 88.1% 1 and 2 years after LSG, respectively. Headaches totally resolved in 13 patients (93.3%) and improved in 1 (P < .001). Pulsatile tinnitus (P = .013), epistaxis, visual symptoms (P < .001), and papilledema (P < .001) significantly resolved. Medication was stopped in 14 patients (93.3%). Two years after LSG, IIH outcomes for 7 patients reaching this time point remained unchanged. This study suggests that LSG is effective for severely obese patients with IIH, resulting in complete remission or significant improvement of their symptoms as well as medication discontinuation.