title: Surgically managed idiopathic intracranial hypertension in adults: a single centre experience.
abstract: BACKGROUND
  Idiopathic intracranial hypertension (IIH) is a rare condition that is often managed conservatively. In patients with aggressive progression of the disease surgical options are considered. There are few data on the outcomes of these patients when surgically managed. We describe our experience of surgically managed IIH and the outcomes of these patients, in particular the surgical revision rate and interventions required for resolution of symptoms.
  
  
  METHODS
  A retrospective review of all patient files coded with benign intracranial hypertension, idiopathic intracranial hypertension or pseudotumour cerebri was undertaken. Files were searched with the date of diagnosis and the date these patients were referred for surgical intervention. The surgical interventions and complications were then documented and note was made of the number of inpatient admissions and days spent in hospital.
  
  
  RESULTS
  From 2000-2013, 79 patients were identified as patients with IIH that had required surgical intervention; 52 % required further surgical intervention. The average number of surgical interventions was 5.6. For patients requiring further intervention the average number of surgical interventions was 8.6. On average patients with IIH also spent 42 inpatient days in neurosurgical beds, whilst those patients who required further intervention spent 63 days on average in neurosurgical beds. The length of the average individual admission was longer for patients requiring repeated surgical interventions.
  
  
  CONCLUSIONS
  Based on our experience, patients that require surgical management of IIH frequently require further surgical interventions to control symptoms and manage complications of CSF diversion surgery. Those that require such further intervention on average will have six further operations and spend significantly longer in hospital. Lumboperitoneal (LP) shunting is an effective first line surgical intervention for 52 % of our patient cohort. This sub-group of patients therefore requires specialist neurosurgical input for this long-term and challenging pathological process.
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK. samir.matloob@me.com.
authors.forename: Samir A
authors.identifier: http://orcid.org/0000-0002-0823-9687
authors.initials: SA
authors.lastname: Matloob
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
authors.forename: Ahmed K
authors.initials: AK
authors.lastname: Toma
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
authors.forename: Lewis
authors.initials: L
authors.lastname: Thorne
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Watkins
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data
keywords: Hydrocephalus; Idiopathic intracranial hypertension; Natural history; Surgical management