Randhawa Sandeep, Van Stavern Gregory P
Department of Ophthalmology, University of Washington, Seattle, Washington, USA.
Curr Opin Ophthalmol. 2008 Nov;19(6):445-53. doi: 10.1097/ICU.0b013e3283112d3e.
To review the current standard of care in the diagnosis and treatment of idiopathic intracranial hypertension (IIH). We also discuss recent advances in the understanding of the pathogenesis of IIH with emerging trends in management of this syndrome.
There has been increasing literature suggesting a role of vitamin A, adipokines, sleep disorders, and venous sinus stenosis in the pathogenesis of IIH. Newer medical treatment options like topiramate and surgical treatment options like stereotactic ventriculoperitoneal shunting have been found to be attractive alternatives. There has also been an emerging interest in cerebral venous sinus stenting, though its role and utility remain debatable.
This article seeks to present a systematic approach to the management of IIH. Many newer treatment modalities are being explored for IIH refractory to standard medical therapy, but their efficacy and safety must be demonstrated in large studies before they can be adopted as part of standard treatment.
回顾特发性颅内高压(IIH)诊断和治疗的当前标准治疗方法。我们还将讨论在IIH发病机制理解方面的最新进展以及该综合征管理的新趋势。
越来越多的文献表明维生素A、脂肪因子、睡眠障碍和静脉窦狭窄在IIH发病机制中起作用。已发现托吡酯等新的药物治疗选择以及立体定向脑室腹腔分流术等手术治疗选择是有吸引力的替代方案。尽管其作用和效用仍存在争议,但对脑静脉窦支架置入术的兴趣也在不断增加。
本文旨在提出一种IIH管理的系统方法。对于标准药物治疗难治的IIH,正在探索许多新的治疗方式,但在它们可被用作标准治疗的一部分之前,必须在大型研究中证明其有效性和安全性。