Department of Neurosurgery, Division of Neuroscience, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.
Br J Neurosurg. 2023 Dec;37(6):1523-1532. doi: 10.1080/02688697.2021.2022097. Epub 2021 Dec 30.
The purpose of this study is to systematically review the literature on the clinical outcomes following different surgical techniques in patients with refractory idiopathic intracranial hypertension (IIH).
IIH is a condition characterised by increased cranial pressure (ICP) in the absence of an intracranial lesion that does not adequately respond to different medical and surgical therapies. Cranial decompression or expansion surgeries are a last resort therapy for patients with refractory IIH.
A systematic literature search of the databases of PubMed, Embase and Medline from inception to 2019 was performed. Searches were limited to the English language and to clinical studies. Studies were included if clinical outcomes following different cranial decompression or expansion techniques were reported. We also add one case of our own experience with performing a bilateral frontoparietal expansion craniotomy and subtemporal craniectomy.
Five manuscripts, describing 38 procedures, met the inclusion criteria. Thirty-one patients were female (82%). The mean age was 26.2 years. The techniques studied included subtemporal craniectomy (27/38, 71%), internal cranial expansion (10/38, 26%), and cranial morcellation decompression (1/38, 3%). Thirty-five patients presented with headaches of which 17 noted postoperative improvement or resolution (49%). Visual deficits were documented in 30 patients and 25 reported postoperative improvement (83%). Papilledema disappeared in 23 of 32 patients with this sign at presentation (72%). In our patient, symptoms completely resolved postoperatively and a 6% increase in intracranial volume was measured.
Cranial vault decompression or expansion surgeries may be an effective last resort therapy for patients with refractory IIH. These surgeries expand the intracranial volume, and thus may normalise ICP, leading to clinical improvement.
本研究旨在系统回顾不同手术技术治疗难治性特发性颅内高压（IIH）患者的临床结局。
IIH 是一种以颅压（ICP）升高为特征的疾病，无颅内病变，对不同的药物和手术治疗反应不佳。对于难治性 IIH 患者，颅腔减压或扩张手术是最后的治疗手段。
从建库到 2019 年，对 PubMed、Embase 和 Medline 数据库进行了系统的文献检索。检索仅限于英文和临床研究。如果报告了不同颅腔减压或扩张技术的临床结局，则纳入研究。我们还增加了我们自己进行双侧额顶扩张颅骨切开术和颞下颅骨切除术的 1 例经验。
符合纳入标准的有 5 篇文献，描述了 38 例手术。31 例为女性（82%）。平均年龄为 26.2 岁。研究的技术包括颞下颅骨切除术（27/38，71%）、颅内扩张术（10/38，26%）和颅骨碎块减压术（1/38，3%）。35 例患者出现头痛，其中 17 例术后头痛改善或缓解（49%）。30 例患者存在视力障碍，其中 25 例术后视力改善（83%）。32 例有乳头水肿的患者中，23 例术后乳头水肿消失（72%）。我们的患者术后症状完全缓解，颅内体积增加 6%。
颅腔减压或扩张手术可能是难治性 IIH 患者的有效最后治疗手段。这些手术扩大了颅内体积，从而可能使 ICP 正常化，导致临床改善。
