Uretsky Scott
Wills Eye Institute, Neuro-Ophthalmology Division, Philadelphia, Pennsylvania 19107, USA.
Curr Opin Ophthalmol. 2009 Nov;20(6):451-5. doi: 10.1097/ICU.0b013e3283313c1c.
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.
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.
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.
特发性颅内高压（IIH）可表现为严重视力丧失，或在接受最大程度的药物治疗后仍持续视力下降；这些情况需要通过手术干预进行积极治疗。迄今为止，最佳手术治疗方案尚未明确界定。本文对近期文献进行综述，以阐明手术干预在IIH中的作用。
迄今为止，尚未进行前瞻性随机研究来比较腰大池-腹腔分流术、脑室-腹腔分流术和视神经鞘开窗/减压术。手术方式的选择似乎基于当地的可及性和专业技术，以及主要症状的突出程度。对于暴发性和药物治疗无效的病例，手术干预延迟会导致更差的视力预后。
在设计良好的多中心临床试验明确哪种干预最适合特定患者之前，IIH的手术干预可能会基于当地的专业技术。
