Long-Term Outcomes of Bariatric Surgery in Idiopathic Intracranial Hypertension Patients

• Published in: The Neurologist (Baltimore, Md.) Vol. 28; no. 2; p. 87
• Main Authors: Hermes, Sam M, Bharadwaj, Madhumithaa, Miller, Nick R, Waslo, Carin, Husain, Farah A, Wolfe, Bruce M, Tanne, Emanuel
• Format: Journal Article
• Language: English
• Published: United States 01.03.2023
• Subjects: Bariatric Surgery; Cross-Sectional Studies; Humans; Intracranial Hypertension; Pseudotumor Cerebri - complications; Pseudotumor Cerebri - surgery; Retrospective Studies; Weight Loss
• ISSN: 2331-2637
• DOI: 10.1097/NRL.0000000000000446

Idiopathic intracranial hypertension (IIH), a rare neurological disorder, has limited effective long-term treatments. Bariatric surgery has shown short-term promise as a management strategy, but long-term efficacy has not been evaluated. We investigated IIH-related outcomes 4 to 16 years postsurgery. This cross-sectional retrospective cohort study included Intracranial Hypertension Registry (IHR) participants with existing medical records that completed a bariatric surgery questionnaire at least 4 years postsurgery. Two physicians independently evaluated the IIH disease course at bariatric surgery and at the time of the questionnaire using detailed medical records. Determinations of improvements were based on within-participant comparisons between the 2 time points. IIH-related outcomes were then combined with bariatric surgery information and outcomes to assess the relationship between weight loss and alterations in IIH. Among participants that underwent bariatric surgery and met study criteria (n=30) the median body mass index (BMI) at the time of surgery was 45.0 [interquartile range (IQR): 39.8-47.0], dropped to a postsurgical nadir of 27.3 (IQR: 22.8-33.1), and rose to 33.4 (IQR: 29.9-41.7) at the time of the questionnaire. Improvements in the IIH disease course at time of the questionnaire occurred in 37% of participants. However, there was a notable association between durable weight loss and IIH improvement as 90% (9 of 10) of participants that attained and maintained a BMI of 30 or below displayed improvement. Attaining and maintaining a BMI of 30 or below was associated with long-term improvement in the IIH disease course, including improved disease management and amelioration of signs and symptoms of participants of the IHR.