From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj).
Can J Surg. 2020 Mar 20;63(2):E123-E128. doi: 10.1503/cjs.016616.
Idiopathic intracranial hypertension (IIH) is a rare condition typically affecting women with obesity who are of child-bearing age. Patients commonly present with headaches, visual disturbances, pulsatile tinnitus and papilledema. The association between IIH and obesity has been well established in the literature, suggesting that weight loss may contribute to improving IIH. For patients with severe obesity for whom conservative management is not successful, bariatric surgery is an effective modality for weight loss. We aimed to systematically review the literature to determine the efficacy of bariatric surgery in the treatment of IIH
We conducted a comprehensive search of MEDLINE, Embase, Scopus, the Cochrane Library and Web of Science (limited to studies in humans published in English between January 1946 and July 2015).
Twelve primary studies (n = 39 patients) were included in the systematic review. All patients had a preoperative diagnosis of IIH. Preoperative body mass index (BMI) was 47.4 ± 3.6 kg/m2 ; BMI improved to 33.7 ± 2.1 kg/m2 and 33.9 ± 11.6 kg/m2 at 6 and 12 months postoperatively, respectively. Lumbar puncture opening pressures decreased from 34.4 ± 6.9 cmH2O to 14.0 ± 3.6 cmH2O after surgery. Common symptoms of IIH improved after bariatric surgery: headaches (100% preoperatively v. 10% postoperatively), visual complaints (62% v. 44%), tinnitus (56% v. 3%) and papilledema (62% v. 8%).
Bariatric surgery appears to lead to considerable improvement in IIH. Idiopathic intracranial hypertension is not a well-publicized comorbidity of obesity, but its presence may be considered as an indication for bariatric surgery.
特发性颅内高压（IIH）是一种罕见的疾病，通常影响肥胖的育龄期女性。患者常出现头痛、视力障碍、搏动性耳鸣和视盘水肿。IIH 与肥胖之间的关联在文献中已得到充分证实，提示减肥可能有助于改善 IIH。对于肥胖严重且保守治疗无效的患者，减重手术是减肥的有效方法。我们旨在系统地综述文献，以确定减重手术治疗 IIH 的疗效。
我们全面检索了 MEDLINE、Embase、Scopus、Cochrane 图书馆和 Web of Science（仅限于 1946 年 1 月至 2015 年 7 月期间以英文发表的人类研究）。
系统综述共纳入 12 项原始研究（n=39 例患者）。所有患者术前均诊断为 IIH。术前体重指数（BMI）为 47.4±3.6kg/m2；术后 6 个月和 12 个月时 BMI 分别改善至 33.7±2.1kg/m2和 33.9±11.6kg/m2。腰椎穿刺开放压从术前的 34.4±6.9cmH2O 降至术后的 14.0±3.6cmH2O。IIH 的常见症状在减重手术后得到改善：头痛（术前 100%，术后 10%）、视力障碍（62%，44%）、耳鸣（56%，3%）和视盘水肿（62%，8%）。
减重手术似乎可显著改善 IIH。特发性颅内高压不是肥胖的广为人知的合并症，但可将其视为减重手术的适应证。
