EFFECTS OF SURGICALLY INDUCED WEIGHT-LOSS ON IDIOPATHIC INTRACRANIAL HYPERTENSION IN MORBID-OBESITY

Background: The effect on CSF pressures and symptoms of weight loss in duced by gastric surgery was studied in morbidly obese patients with i diopathic intracranial hypertension (IIH). Methods: Gastric weight red uction surgery was performed in eight morbidly obese women (49 +/- 3 k g/m(2) body mass index) who had IIH and elevated CSF pressures. Each h ad been treated medically for IIH. Two had ventriculoperitoneal shunts , with occlusion in both and hemorrhage and hemiparesis in one. Post-w eight-reduction measurement of CSF pressures, signs and symptoms of II H, and obesity co-morbidity were evaluated. Results: CSF pressures dec reased in all eight patients, from a mean of 353 +/- 35 to a mean of 1 68 +/- 12 mm H2O (p < 0.001), following mean weight loss of 57 +/- 5 k g (p < 0.001) when measured at 34 +/- 8 months after surgery. At follo w-up no patient had papilledema, all eight patients had resolution or marked reduction of headache, and resolution of tinnitus occurred in a ll six patients with this symptom. Neuroimaging was unchanged at 27 +/ - 6 months after surgery in six patients. There was also resolution or clinical improvement of additional obesity-related co-morbidity, incl uding diabetes, hypertension, sleep apnea, obesity hypoventilation, jo int pains, stress urinary incontinence, and gastroesophageal reflux. C onclusions: Although several complications occurred following obesity surgery over the 11 years of this study, the current low morbidity and mortality with gastric bypass make this a primary option in the sever ely obese patient with IIH.