Laparoscopic sleeve gastrectomy for the treatment of idiopathic intracranial hypertension in patients with severe obesity

Panagiotis Lainas; Toni El Soueidy; Imed Ben Amor; Rodi Courie; Gabriel Perlemuter; Jean Gugenheim; Ibrahim Dagher

doi:10.1016/j.soard.2020.07.034

Laparoscopic sleeve gastrectomy for the treatment of idiopathic intracranial hypertension in patients with severe obesity

Surg Obes Relat Dis. 2020 Dec;16(12):1971-1977. doi: 10.1016/j.soard.2020.07.034. Epub 2020 Aug 11.

Authors

Panagiotis Lainas¹, Toni El Soueidy², Imed Ben Amor³, Rodi Courie⁴, Gabriel Perlemuter⁵, Jean Gugenheim³, Ibrahim Dagher⁶

Affiliations

¹ Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, Clamart, France; Paris-Saclay University, Orsay, France. Electronic address: panagiotis.lainas@aphp.fr.
² Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, Clamart, France.
³ Department of Digestive Surgery, Archet II Hospital, Nice, France; University of Nice-Sophia-Antipolis, Nice, France.
⁴ Department of Hepatogastroenterology, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, Clamart, France.
⁵ Paris-Saclay University, Orsay, France; Department of Hepatogastroenterology, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, Clamart, France.
⁶ Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, Clamart, France; Paris-Saclay University, Orsay, France.

PMID: 32988746
DOI: 10.1016/j.soard.2020.07.034

Abstract

Background: Severe obesity is a major risk factor for idiopathic intracranial hypertension (IIH). Data on the role of bariatric surgery for the treatment of this condition are scarce.

Objective: To evaluate the effectiveness of laparoscopic sleeve gastrectomy (LSG) on treating IIH in severely obese patients.

Setting: Two university bariatric surgery centers.

Methods: Prospectively collected data from consecutive patients undergoing LSG were retrospectively analyzed. Patients with IIH and referred by neuroophthalmologists for bariatric surgery were included in the analysis.

Results: Fifteen female patients with IIH underwent LSG (median age: 31 yr). Median preoperative body mass index was 42.1 kg/m². Preoperatively, 14 patients (93.3%) had chronic headaches, 8 (53.3%) pulsatile tinnitus, and 1 (6.6%) epistaxis episodes. Ophthalmologic assessment showed bilateral papilledema in all patients, of whom 13 had visual symptoms. Median initial cerebrospinal fluid opening pressure was 31 cmH₂ O (range: 25-50 cmH₂ O); 4 patients required repeated decompressing lumbar punctures (1 ventriculoperitoneal shunt). LSG was successfully performed in all patients. No patients were lost to follow-up. Mean excess weight loss was and 87.4% and 88.1% 1 and 2 years after LSG, respectively. Headaches totally resolved in 13 patients (93.3%) and improved in 1 (P < .001). Pulsatile tinnitus (P = .013), epistaxis, visual symptoms (P < .001), and papilledema (P < .001) significantly resolved. Medication was stopped in 14 patients (93.3%). Two years after LSG, IIH outcomes for 7 patients reaching this time point remained unchanged.

Conclusion: This study suggests that LSG is effective for severely obese patients with IIH, resulting in complete remission or significant improvement of their symptoms as well as medication discontinuation.

Keywords: Bariatric surgery; IIH; Idiopathic intracranial hypertension; Laparoscopy; Pseudotumor cerebri; Sleeve gastrectomy; Weight loss surgery.

MeSH terms

Adult
Bariatric Surgery*
Body Mass Index
Female
Gastrectomy
Humans
Laparoscopy*
Obesity, Morbid* / complications
Obesity, Morbid* / surgery
Pseudotumor Cerebri* / complications
Pseudotumor Cerebri* / surgery
Retrospective Studies
Treatment Outcome