Comparison of bariatric surgery and community weight management for idiopathic intracranial hypertension in a multicenter retrospective cohort study

Idiopathic Intracranial Hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure without definitive etiology, primarily affecting young, obese women. This study aimed to compare the efficacy of bariatric surgery versus conventional community weight management in treating IIH. We conducted a retrospective cohort study in IIH patients undergoing bariatric procedures versus conventional weight loss interventions. Propensity score matching was employed to balance study groups. Outcomes were assessed at 3, 6, 12, and 24 months, including papilledema, headache, visual symptoms, and therapeutic interventions. Bariatric surgery demonstrated superior outcomes compared to community weight management. Papilledema incidence was consistently lower in the bariatric group (RR = 0.591 at 24 months, p = 0.0001). Headache prevalence and visual symptoms were also reduced in the surgical group. Acetazolamide dose was lower in bariatric patients, starting at 12 and 24 months. Subgroup analysis of different bariatric procedures showed comparable efficacy. Body mass index reduction was significantly greater in the bariatric group throughout the follow-up period. This study provides evidence supporting the efficacy of bariatric surgery in managing IIH, with superior outcomes across multiple parameters compared to conventional weight management. The sustained improvements in papilledema, headache, and visual symptoms, coupled with for the reduction in pharmacological intervention dose, suggest that bariatric surgery may offer a more definitive solution for IIH patients with concurrent obesity. Further research is needed to develop evidence-based guidelines for patient selection and optimize post-operative care protocols.