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From the General/Trauma Surgery Division, Department of Surgery (Drs. Sugerman and Kellum), the Division of Neuro-ophthalmology, Departments of Neurology and Ophthalmology (Dr. Felton), the Neurosurgical Division, Department of Surgery (Dr. Salvant), and the Department of Otorhinolaryngology (Dr. Sismanis), Medical College of Virginia, Virginia Commonwealth University, Richmond, VA.
Received November 9, 1994. Accepted in final form February 10, 1995.
Address correspondence and reprint requests to Dr. Harvey J. Sugerman, Medical College of Virginia, P.O. Box 519, MCV Station, Richmond, VA 23298-0519.
Background: The effect on CSF pressures and symptoms of weight loss induced by gastric surgery was studied in morbidly obese patients with idiopathic intracranial hypertension (IIH). Methods: Gastric weight reduction surgery was performed in eight morbidly obese women (49 plus minus 3 kg/m2 body mass index) who had IIH and elevated CSF pressures. Each had been treated medically for IIH. Two had ventriculoperitoneal shunts, with occlusion in both and hemorrhage and hemiparesis in one. Post--weight-reduction measurement of CSF pressures, signs and symptoms of IIH, and obesity co-morbidity were evaluated. Results: CSF pressures decreased in all eight patients, from a mean of 353 plus minus 35 to a mean of 168 plus minus 12 mm H2 O (p less than 0.001), following mean weight loss of 57 plus minus 5 kg (p less than 0.001) when measured at 34 plus minus 8 months after surgery. At follow-up no patient had papilledema, all eight patients had resolution or marked reduction of headache, and resolution of tinnitus occurred in all six patients with this symptom. Neuroimaging was unchanged at 27 plus minus 6 months after surgery in six patients. There was also resolution or clinical improvement of additional obesity-related co-morbidity, including diabetes, hypertension, sleep apnea, obesity hypoventilation, joint pains, stress urinary incontinence, and gastroesophageal reflux. Conclusions: 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 severely obese patient with IIH.
NEUROLOGY 1995;45: 1655-1659
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