Bariatric surgery as a treatment for pseudotumor cerebri
case study and narrative review of the literature
Keywords:
Pseudotumor cerebri, Obesity, Bariatric surgery, Gastric bypass, Intracranial hypertensionAbstract
CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of child-bearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hipertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH2O. She presented a body mass index of 39.5 kg/m2, also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH2O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm.
Downloads
References
Corbett JJ,Savino PJ, Thompson HS, et al. Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol. 1982;39(8):461-74.
Hainline C, Rucker JC, Balcer LJ. Current concepts in pseudotumor cerebri. CurrOpin Neurol. 2016;29(1):84-93.
Wakerley BR, Tan MH, Ting EY. Idiopathic intracranial hypertension. Cephalalgia. 2015;35(3):248-61.
Kesler A, Stolovic N, BluednikovY, ShohatT.The incidence of idiopathic intracranial hypertension in Israel from 2005 to 2007: results of a nationwide survey. Eur J Neurol. 2014;21(8):1055-9.
Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81(13):1159-65.
Mallery RM, Friedman DI, Liu GT. Headache and the pseudotumor cerebri syndrome. Curr Pain Headache Rep. 2014;18(9):446.
OCT Sub-Study Committee for NORDIC Idiopathic Intracranial Hypertension Study Group, Auinger P, Durbin M, et al. Baseline OCT measurements in the idiopathic intracranial hypertension treatment trial, part I: quality control, comparisons, and variability. Invest Ophthalmol Vis Sci. 2014;55(12):8180-8.
Kalyvas AV, Hughes M, Koutsarnakis C, et al. Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature. Acta Neurochir (Wien).2017;159(1):33-49.
Roth J, Constantini S, Kesler A. Over-drainage and persistent shuntdependency in patients with idiopathic intracranial hypertension treated with shunts and bariatric surgery. Surg Neurol Int. 2015;6(Suppl 27):S655-60.
Handley JD, Baruah BP, Williams DM, et al. Bariatric surgery as a treatment for idiopathic intracranial hypertension: a systematic review. Surg Obes Relat Dis. 2015;11(6):1396-403.
Levin AA, Hess D, Hohler AD. Treatment of idiopathic intracranial hypertension with gastric bypass surgery. Int J Neurosci. 2015;125(1 ):78-80.
Egan RJ, Meredith HE, Coulston JE, et al. The effects of laparoscopic adjustable gastric banding on idiopathic intracranial hypertension. Obes Surg. 2011 ;21 (2):161-6.
Fridley J, Foroozan R, Sherman V, Brandt ML,Yoshor D. Bariatric surgery for the treatment of idiopathic intracranial hypertension. J Neurosurg. 2011;114(1):34-9.
Williams A, Morgan J, Johnson A, et al. Resolution of Pseudotumor Cerebri following surgery for morbid obesity. J Surg Case Rep. 2010;2010(6):7.
Stangherlin P, Ledeghen S, Scordidis V, Rubay R. Benign intracranial hypertension with recurrent spontaneous cerebrospinal fluid rhinorrhoea treated by laparoscopic gastric banding. Acta Chir Belg. 2008;108(5):616-8.
Leslie DB, Kellogg TA, Boutelle KN, et al. Preserved vision without growth retardation after laparoscopic Roux-en-Y gastric bypass in a morbidly obese child with pseudotumor cerebri: 36-month follow-up. J Pediatr Surg. 2008;43(7):e27-30.
Chandra V, Dutta S, Albanese CT, et al. Clinical resolution of severely symptomatic pseudotumor cerebri after gastric bypass in an adolescent. Surg Obes Relat Dis. 2007;3(2):198-200.
Soto FC, Antozzi P, Szomstein S, et, al. Indication for emergent gastric bypass in a patient with severe idiopathic intracranial hypertension: case report and review of the literature. Surg Obes Relat Dis. 2005;1 (5):503-5.
Lazcano-Herrera EE, Romero-Hernández T, Martínez-Ordaz JL, BlancoBenavides R.Tratamiento del pseudotumor cerebri con cirugia bariátrica. Reporte de un caso. Cirugia y Cirujanos. 2005;73(5):375-8. Available from: http://www.medigraphic.com/pdfs/circir/cc-2005/cc055i.pdf Accessed in 2017 (Feb 6).
Nadkarni T, Rekate HL, Wallace D. Resolution of pseudotumor cerebri after bariatric surgery for related obesity. Case report. J Neurosurg. 2004;101(5):878-80.
Fontes D, Sanches MD, Nascimento SZ, et al. Cirurgia bariátrica no tratamento do pseudotumor cerebral: relato de caso [Bariatric surgery for treatment of pseudotumor cerebro: a case report]. Rev Méd Minas Gerais. 2003;13(4):292-3.
Sugerman HJ, Felton WL 3rd, Sismanis A, et al. Gastric surgery for pseudotumor cerebri associated with severe obesity. Ann Surg. 1999;229(5):634-40; discussion 640-2.