Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension.

OBJECT: The object of this study was to compare surgical techniques for management of visual loss in idiopathic intracranial hypertension (IIH) unresponsive to medical treatment.

METHODS: The published literature was reviewed using electronic and manual search techniques. Articles were categorized based upon the surgical procedure performed, including optic nerve sheath decompression (ONSD), also called optic nerve sheath fenestration; intracranial venous sinus stent placement; ventriculoperitoneal (VP) shunt placement; and lumboperitoneal (LP) shunt placement. Demographic data and visual outcome of the cumulative experience were compiled and compared for each type of surgical intervention.

RESULTS: Seventeen patients treated by stent placement, 31 by VP shunt placement, 44 by LP shunt placement, and 252 patients by ONSD were identified in the literature; average follow-up ranged from 11.8 months for patients treated with stents to 57.2 months for those treated with LP shunts. Improved or resolved vision deficit was noted in 38.7% of patients after VP shunt placement, 47% of patients after stent placement, 44.6% of patients after LP shunt placement, and 80% of eyes after ONSD. Visual worsening was rare for all procedures evaluated.

CONCLUSIONS: There is a paucity of information regarding visual outcomes from intracranial venous stent placement and cerebrospinal fluid diversion procedures. Visual outcomes from ONSD are better documented and appear to be superior to other surgical techniques for management of IIH. Further studies with improved data collection regarding visual outcomes are needed for surgical procedures other than ONSD in order to assess their possible value as treatments for visual loss in IIH.