Recent Trends in the Surgical Treatment of Idiopathic Intracranial Hypertension: A Systematic Review

Background: Idiopathic intracranial hypertension (IIH) is a complex neurological condition with multifactorial origins, predominantly affecting obese women of reproductive age. This systematic review aims to explore recent trends in the surgical treatment of idiopathic intracranial hypertension. Methods: This systematic review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search encompassed an extensive database including PubMed, Science Direct and Cochrane library. Studies published from 2014-2024 were included in the analysis. The quality of the included studies was evaluated using the proper tools suited to the study design. The synthesis and analysis of data included a summary of study characteristics, aims and objectives, surgical technique, and main study results/conclusions. Results: Sample sizes in the selected studies ranged from 7 to 46,065 participants. The most common surgical techniques used for idiopathic intracranial hypertension were venous sinus stenting (VSS), CSF Diversion: Lumboperitoneal (LP) shunting and ventriculoperitoneal (VP) shunting, lumbopleural shunting, bariatric surgery and optic nerve sheath fenestration (ONSF). Generally, the studies discovered the increasing trends in venous sinus stenting procedures in the management of IIH and emphasised bariatric surgery’s effectiveness over community weight management interventions in lowering intracranial pressure and aiding weight loss. Overall, these studies present a diverse range of treatment approaches, with a focus on efficiency and outcomes in managing IIH. Conclusion: This systematic review concludes that various surgical techniques, such as VP shunting, LP shunting with programmable valves, ONSF, venous sinus stenting and bariatric surgery are helpful in the management of IIH. Venous sinus stenting emerges as a promising surgical intervention for medically refractory IIH, offering substantial symptomatic relief with minimal risks.