Portelli Mark, Papageorgiou Panagiotis N
Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK.
Department of Neurointensive Care Unit, Southampton University Hospital, Tremona Road, SO16 6YD, Southampton, UK.
Acta Neurochir (Wien). 2017 Mar;159(3):491-499. doi: 10.1007/s00701-016-3050-7. Epub 2016 Dec 24.
Idiopathic intracranial hypertension (IIH) is still a grey area in the knowledge of the aetiology, diagnosis and management of neurosurgical diseases. The definition of IIH has been reviewed over time and many hypotheses have been expressed as cause of the disease. The literature supplies very little evidence-based information to guide our decision-making process when it comes to treat the disease. In this review we sum up the latest information regarding the aetiology and therapy of IIH. Additionally, we make an attempt to unify the diagnostic criteria of Dandy, Friedman and Wall established from 1937 to date.
In this narrative review, we attempt to update the current standpoint to IIH, evaluate the input until now and consider future directions for research. The vast majority of the literature consisted of cohort studies, case control studies, systematic reviews and other narrative reviews.
Pathophysiology: The incidence of IIH is steadily increasing. Several pathophysiological theories have been proposed in the literature based on the flow of cerebrospinal fluid.
We attempt to fuse all the three diagnostic approaches published in the literature that detect IIH, while preserving the individual characteristics of each approach.
Based on evidence-based trials, the current use of acetazolamide in comparison with placebo or with topiramate has been evaluated. In the interventions' field, there seems to be a consonance about the alarming symptoms and what the most suitable operation is in each case. There is some disagreement about the indications for venous sinus transversus stenting and its risk/benefit ratio.
Until now there is no class I guideline to which our decision-making can be based on for the management of IIH. A lack of systematic reviews and randomised control trials has been noted. If we focused our research on that, we could develop a standardised treatment protocol.
特发性颅内高压（IIH）在神经外科疾病的病因、诊断和治疗方面仍是一个知识盲区。随着时间的推移，IIH的定义不断被重新审视，关于该疾病病因的假说也层出不穷。在治疗该疾病时，文献提供的循证信息非常有限，难以指导我们的决策过程。在本综述中，我们总结了有关IIH病因和治疗的最新信息。此外，我们试图统一自1937年至今由丹迪、弗里德曼和沃尔建立的诊断标准。
在本叙述性综述中，我们试图更新对IIH的当前观点，评估迄今为止的研究成果，并考虑未来的研究方向。绝大多数文献包括队列研究、病例对照研究、系统评价和其他叙述性综述。
病理生理学：IIH的发病率在稳步上升。基于脑脊液流动，文献中提出了几种病理生理学理论。
我们试图融合文献中发表的所有三种检测IIH的诊断方法，同时保留每种方法的个体特征。
基于循证试验，评估了目前使用乙酰唑胺与安慰剂或托吡酯相比的情况。在干预领域，对于警示症状以及每种情况下最合适的手术方式似乎存在共识。关于静脉窦横窦支架置入术的适应症及其风险/效益比存在一些分歧。
到目前为止，尚无I类指南可作为我们管理IIH决策的依据。已注意到缺乏系统评价和随机对照试验。如果我们将研究重点放在这方面，就可以制定标准化的治疗方案。
