Midterm benefits of metabolic surgery on symptom remission and medication use in patients with pseudotumor cerebri

Published:December 20, 2022DOI:



      Pseudotumor cerebri is a serious obesity-related disorder that can result in severe complications. The aim of this study was to compare metabolic surgery with medical management of pseudotumor cerebri at a single bariatric center.


      After institutional review board approval, a retrospective review was conducted of individuals with severe obesity and pseudotumor cerebri (nonbariatric group) and patients with preoperative pseudotumor cerebri (bariatric group). The variables included demographic characteristics, comorbidities, and pseudotumor cerebri–related risk factors. Symptoms, medication use, and body mass index were analyzed during a 4-year follow-up.


      A total of 86 patients with pseudotumor cerebri were included in the analysis. In the nonbariatric group (n = 77), the mean age was 34.1 ± 10.5 years and initial body mass index 37.2 ± 6.5 kg/m2. Initially, the most common symptom was headache (90.9%; n = 70), with a mean lumbar opening pressure of 341.94 ± 104.50 mm H2O. In the bariatric group (n = 9), the mean age was 36.1 ± 8.9 years and preoperative body mass index 46.1 ± 5.5 kg/m2. The most common preoperative symptom was headache (100%; n = 9), with a lumbar opening pressure of 320 ± 44.27 mm H2O. During the 4-year follow-up, both groups presented with a significant decrease in pseudotumor cerebri–related symptoms at 3 months (P < .0001). Additionally, pseudotumor cerebri medication use significantly decreased after 3 months in the bariatric group (P = .0406), whereas in the nonbariatric group decreased at 18 months (P = .023). Bariatric patients presented with a significant decrease in body mass index in ≤3 months of surgery (P = .0380), which was not observed in nonbariatric patients (P = .6644).


      Metabolic surgery seems to provide a greater decrease in pseudotumor cerebri symptoms and medication use in a shorter period of time compared with medical management alone.
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        • Stevenson S.B.
        Pseudotumor cerebri: yet another reason to fight obesity.
        J Pediatr Health Care. 2008; 22: 40-43
        • Hainline C.
        • Rucker J.C.
        • Balcer L.J.
        Current concepts in pseudotumor cerebri.
        Curr Opin Neurol. 2016; 29: 84-93
        • Wakerley B.R.
        • Tan M.H.
        • Ting E.Y.
        Idiopathic intracranial hypertension.
        Cephalalgia. 2015; 35: 248-261
        • Mancera N.
        • Murr M.M.
        • Drucker M.
        Bariatric surgery and its impact on pseudotumor cerebri: a case report.
        Am J Ophthalmol Case Rep. 2018; 10: 68-70
        • Handley J.D.
        • Baruah B.P.
        • Williams D.M.
        • et al.
        Bariatric surgery as a treatment for idiopathic intracranial hypertension: a systematic review.
        Surg Obes Relat Dis. 2015; 11: 1396-1403
        • Cazzo E.
        • Gestic M.A.
        • Utrini M.P.
        • et al.
        Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature.
        Sao Paulo Med J. 2018; 136: 182-187
        • Biousse V.
        • Bruce B.B.
        • Newman N.J.
        Update on the pathophysiology and management of idiopathic intracranial hypertension.
        J Neurol Neurosurg Psychiatry. 2012; 83: 488-494
        • Yri H.M.
        • Wegener M.
        • Sander B.
        • Jensen R.
        Idiopathic intracranial hypertension is not benign: a long-term outcome study.
        J Neurol. 2012; 259: 886-894
        • Soto F.C.
        • Antozzi P.
        • Szomstein S.
        • et al.
        Indication for emergent gastric bypass in a patient with severe idiopathic intracranial hypertension: case report and review of the literature.
        Surg Obes Relat Dis. 2005; 1: 503-505
        • Friedman D.I.
        • Liu G.T.
        • Digre K.B.
        Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children.
        Neurology. 2013; 81: 1159-1165
        • Baykan B.
        • Ekizoğlu E.
        • Uzun G.A.
        An update on the pathophysiology of idiopathic intracranial hypertension alias pseudotumor cerebri.
        Ağrı. 2015; 27: 63-72
        • Dip F.
        • Nguyen D.
        • Sasson M.
        • et al.
        The relationship between intracranial pressure and obesity: an ultrasonographic evaluation of the optic nerve.
        Surg Endosc. 2016; 30: 2321-2325
        • Montorfano L.
        • Giambartolomei G.
        • Funes D.R.
        • et al.
        The Cushing reflex and the vasopressin-mediated hemodynamic response to increased intracranial pressure during acute elevations in intraabdominal pressure.
        Surgery. 2020; 167: 478-483
        • Giuseffi V.
        • Wall M.
        • Siegel P.Z.
        • Rojas P.B.
        Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study.
        Neurology. 1991; 41: 239-244
        • Corbett J.J.
        • Savino P.J.
        • Thompson H.S.
        • et al.
        Visual loss in pseudotumor cerebri: follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss.
        Arch Neurol. 1982; 39: 461-474
        • Wall M.
        • George D.
        Idiopathic intracranial hypertensiona prospective study of 50 patients.
        Brain. 1991; 114: 155-180
        • Liu G.T.
        Pseudotumor cerebri and its medical treatment.
        Drugs Today (Barc). 1998; 34: 563-574
        • Kesler A.
        • Hadayer A.
        • Goldhammer Y.
        • et al.
        Idiopathic intracranial hypertension: risk of recurrences.
        Neurology. 2004; 63: 1737-1739
        • Corbett J.J.
        • Thompson H.S.
        The rational management of idiopathic intracranial hypertension.
        Arch Neurol. 1989; 46: 1049-1051
        • Schiavon C.A.
        • Ikeoka D.T.
        • de Sousa M.G.
        • et al.
        Effects of gastric bypass surgery in patients with hypertension: rationale and design for a randomised controlled trial (GATEWAY study).
        BMJ Open. 2014; 4e005702
        • Vetter M.L.
        • Ritter S.
        • Wadden T.A.
        • Sarwer D.B.
        Comparison of bariatric surgical procedures for diabetes remission: efficacy and mechanisms.
        Diabetes Spectr. 2012; 25: 200-210
        • Spivak H.
        • Sakran N.
        • Dicker D.
        • et al.
        Different effects of bariatric surgical procedures on dyslipidemia: a registry-based analysis.
        Surg Obes Relat Dis. 2017; 13: 1189-1194
        • Hariri K.
        • Kini S.U.
        • Herron D.M.
        • Fernandez-Ranvier G.
        Resolution of symptomatic obstructive sleep apnea not impacted by preoperative body mass index, choice of operation between sleeve gastrectomy and Roux-en-Y gastric bypass surgery, or severity.
        Obes Surg. 2018; 28: 1402-1407
        • Sugerman H.J.
        • Felton 3rd, W.L.
        • Sismanis A.
        • et al.
        Gastric surgery for pseudotumor cerebri associated with severe obesity.
        Ann Surg. 1999; 229: 634-640
        • Kalyvas A.V.
        • Hughes M.
        • Koutsarnakis C.
        • et al.
        Efficacy, complications and cost of surgical interventions for idiopathic intracranial hypertension: a systematic review of the literature.
        Acta Neurochir (Wien). 2017; 159: 33-49
        • Fridley J.
        • Foroozan R.
        • Sherman V.
        • et al.
        Bariatric surgery for the treatment of idiopathic intracranial hypertension.
        J Neurosurg. 2011; 114: 34-39
        • Manfield J.H.
        • Yu K.K.-H.
        • Efthimiou E.
        • et al.
        Bariatric surgery or non-surgical weight loss for idiopathic intracranial hypertension? A systematic review and comparison of meta-analyses.
        Obes Surg. 2017; 27: 513-521