Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature

ABSTRACT CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of child-bearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH2O. She presented a body mass index of 39.5 kg/m2, also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH2O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm.

背景：假性脑瘤（Pseudotumor cerebri）指无明确潜在病因的颅内压升高病症，常导致视力丧失，该病最常见于育龄肥胖女性。
病例报告：一名46岁女性因特发性颅内高压（idiopathic intracranial hypertension）就诊于我科，该疾病于2年前确诊，曾引发慢性难治性头痛，伴双眼视乳头水肿，估算视敏度丧失达30%。患者服用乙酰唑胺（Acetazolamide）后头痛症状部分缓解，但视力丧失仍持续存在。其颅内压为34 cmH₂O，体质量指数（Body Mass Index, BMI）为39.5 kg/m²，同时合并高血压。静脉增强颅脑计算机断层扫描（Computed Tomography of the Cranium with Endovenous Contrast）未见异常。患者接受了Roux-en-Y胃旁路术（Roux-en-Y Gastric Bypass），术后病程平稳。术后1个月，患者超额体重丢失达24%。眼科检查显示视力丧失症状消失，视乳头水肿缓解，术后未再出现头痛发作，高血压亦完全缓解。术后6个月，患者颅内压降至24 cmH₂O。
结论：尽管该病通常与肥胖相关，但目前关于减重代谢手术（bariatric surgery）治疗假性脑瘤的报道较少。既往研究病例中，接受减重代谢手术后疾病缓解或改善的比例较高。目前尚无公认的优选手术技术，因此需开展进一步研究以制定特异性诊疗流程。