Internal cranial expansion surgery for the treatment of refractory idiopathic intracranial hypertension

Clinical article

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  • 1 Department of Neurological Surgery, Columbia University Medical Center; and
  • 2 Department of Neurological Surgery, St. Luke's-Roosevelt Hospital Center, New York, New York
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Object

Idiopathic intracranial hypertension (IIH) may be refractory to available medical and surgical therapies. Patients with this condition may suffer from intractable headaches, experience visual deterioration, or have other symptoms related to elevated intracranial pressure. Internal cranial expansion (ICE) is a novel surgical procedure that the authors have developed for the treatment of patients with this condition. Here, they describe ICE and present their initial experience in using this surgical procedure for the treatment of patients with refractory IIH.

Methods

The authors conducted a retrospective review of 10 consecutive patients who underwent ICE for the treatment of IIH during a 5-year period. Preoperative and postoperative clinical parameters including patient symptoms, presence of papilledema, and available ICP or CSF opening pressures were compared. Procedural details and complications were noted. Intracranial volume increases were calculated using available pre- and postoperative CT scans.

Results

Follow-up for the 10 patients in this series ranged from 1 to 39.6 months (mean 15.5 months). Technically successful ICE was performed in all patients within the cohort. Surgical complications included a single postoperative seizure in one patient and a sagittal sinus tear with no clinical sequelae in another patient. At the time of last follow-up, 7 (70%) of 10 patients were either symptomatically improved or asymptomatic. Six (67%) of 9 patients with preoperative headaches had reduction or resolution of this symptom, and all patients (4 of 4) with preoperative papilledema had a reduction in or complete resolution of this sign. Postoperative ICP or CSF opening pressures were normal in all patients (4 of 4) tested. Postoperative intracranial volume expansion ranged between 3.8% and 12%.

Conclusions

Internal cranial expansion is a safe and effective surgery for the treatment of patients with refractory IIH. This surgery expands the intracranial volume and thus promotes ICP normalization, which may lead to the reduction or complete resolution of the signs and symptoms of IIH. Internal cranial expansion may be used as part of a multidisciplinary management approach in the treatment of refractory IIH.

Abbreviations used in this paper:BMI = body mass index; ICE = internal cranial expansion; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension; LP = lumboperitoneal; ONSF = optic nerve sheath fenestration; VP = ventriculoperitoneal.

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Contributor Notes

Address correspondence to: Saadi Ghatan, M.D., Department of Neurological Surgery, Columbia University Medical Center, 16 East 60th Street, Suite 450, New York, New York 10022. email: sg2160@columbia.edu.

Please include this information when citing this paper: published online June 15, 2012; DOI: 10.3171/2012.3.PEDS11228.

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