Surgical interventions for idiopathic intracranial hypertension.
OBJECTIVE
Idiopathic intracranial hypertension (IIH) can present with severe loss of vision or with ongoing vision loss despite maximal medical therapy; these situations require aggressive management with surgical interventions. To date, optimal surgical management has not been clearly defined. A review of the recent literature is undertaken to clarify the role of surgical interventions in IIH.


RESULTS
To date, no prospective, randomized study has been performed comparing lumboperitoneal shunt, ventriculoperitoneal shunt and optic nerve sheath fenestration/decompression. Procedure choice appears to be based on local availability and expertise, as well as the prominence of presenting symptoms. Delay in surgical intervention for fulminant and medically refractory cases leads to worse visual outcomes.


CONCLUSIONS
Surgical intervention for IIH will likely be based on local expertise until well designed, multicentered clinical trials clarify which intervention best suits a particular patient.
Uretsky
Scott
S
Wills Eye Institute, Neuro-Ophthalmology Division, Philadelphia, Pennsylvania 19107, USA. uretsx@gmail.com
D002557:Cerebrospinal Fluid Shunts; D019299:Decompression, Surgical; D006801:Humans; D008161:Lumbosacral Region; D009186:Myelin Sheath; D013508:Ophthalmologic Surgical Procedures; D009900:Optic Nerve; D011559:Pseudotumor Cerebri / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt