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Background:The effect on CSF pressures and symptoms of weight loss induced by gastric surgery was studied in morbidly obese patients with idiopathic intracranial hypertension(IIH).Methods:Gastric weight reduction surgery was performed in eight morbidly obese women(49+/-3 kg/m2 body mass index) who had IIH and elevated CSF pressures.Each had been treated medically for IIH.Two had ventriculoperitoneal shunts,with occlusion in both and hemorrhage and hemiparesis in one.Post-weight-reduction measurement of CSF pressures,signs and symptoms of IIH,and obesity co-morbidity were evaluated.Results:CSF pressures decreased in all eight patients,from a mean of 353+/-35 to a mean of 168+/-12 mm H2O(p<0.001),following mean weight loss of 57+/-5 kg(p<0.001)when measured at 34+/-8 months after surgery.At follow-up no patient had papilledema,all eight patients had resolution or marked reduction of headache,and resolution of tinnitus occurred in all six patients with this symptom.Neuroimaging was unchanged at 27+/-6 months after surgery in six patients.There was also resolution or clinical improvement of additional obesity-related co-morbidity, including diabetes,hypertension,sleep apnea,obesity hypoventilation,joint pains,stress urinary incontinence,and gastroesophageal reflux.Conclusions: Although several complications occurred following obesity surgery over the 11 years of this study,the current low morbidity and mortality with gastric bypass make this a primary option in the severely obese patient with IIH. |
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