RSS-Feed abonnieren
DOI: 10.1055/s-0045-1812508
Idiopathic Intracranial Hypertension
Autoren
Abstract
Objective
Idiopathic intracranial hypertension (IIH) is a not well-understood syndrome of raised intracranial pressure, with a disproportionately higher incidence in obese women. This article summarizes the epidemiology and clinical features, and the diagnostic evaluation and management options of IIH, with a focus on venous sinus stenting as a promising treatment option.
Results
With growing obesity levels, IIH incidence has shown a commensurate increase globally. Our understanding of the pathophysiology of this condition continues to remain limited. Diagnostic modalities and criteria have evolved over the years with better imaging technology. Symptom management and preservation of vision form the cornerstone of most treatment strategies. Acetazolamide and topiramate are the first-line drugs of choice for medical management. Surgical interventions are essential in medically refractory cases or in cases of fulminant IIH. Sinus venous stenting is growing in popularity as a safe and effective surgical alternative.
Conclusion
There exists a dearth of randomized controlled trials to guide our treatment strategies in patients with IIH. Although Venous sinus stenting offers a safe and effective treatment option in medically refractory cases, variability in various aspects of the procedure is extensive.
Publikationsverlauf
Artikel online veröffentlicht:
20. November 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Thurtell MJ. Idiopathic intracranial hypertension. Continuum (Minneap Minn) 2019; 25 (05) 1289-1309
- 2 Kanagalingam S, Subramanian PS. Update on idiopathic intracranial hypertension. Curr Treat Options Neurol 2018; 20 (07) 24
- 3 Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol 2016; 15 (01) 78-91
- 4 Portelli M, Papageorgiou PN. An update on idiopathic intracranial hypertension. Acta Neurochir (Wien) 2017; 159 (03) 491-499
- 5 Kilgore KP, Lee MS, Leavitt JA. et al. Re-evaluating the incidence of idiopathic intracranial hypertension in an era of increasing obesity. Ophthalmology 2017; 124 (05) 697-700
- 6 Raoof N, Sharrack B, Pepper IM, Hickman SJ. The incidence and prevalence of idiopathic intracranial hypertension in Sheffield, UK. Eur J Neurol 2011; 18 (10) 1266-1268
- 7 Daniels AB, Liu GT, Volpe NJ. et al. Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol 2007; 143 (04) 635-641
- 8 Farb RI, Vanek I, Scott JN. et al. Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 2003; 60 (09) 1418-1424
- 9 Riggeal BD, Bruce BB, Saindane AM. et al. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology 2013; 80 (03) 289-295
- 10 Fargen KM, Coffman S, Torosian T, Brinjikji W, Nye BL, Hui F. “Idiopathic” intracranial hypertension: An update from neurointerventional research for clinicians. Cephalalgia 2023; 43 (04) :03331024231161323
- 11 King JO, Mitchell PJ, Thomson KR, Tress BM. Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology 2002; 58 (01) 26-30
- 12 Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81 (13) 1159-1165
- 13 Giuseffi V, Wall M, Siegel PZ, Rojas PB. Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study. Neurology 1991; 41 (2[Pt 1]): 239-244
- 14 Wall M, Kupersmith MJ, Kieburtz KD. et al; NORDIC Idiopathic Intracranial Hypertension Study Group. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol 2014; 71 (06) 693-701
- 15 Friedman DI, Rausch EA. Headache diagnoses in patients with treated idiopathic intracranial hypertension. Neurology 2002; 58 (10) 1551-1553
- 16 Friedman DI, Quiros PA, Subramanian PS. et al; and the NORDIC IIHTT Study Group. Headache in idiopathic intracranial hypertension: findings from the idiopathic intracranial hypertension treatment trial. Headache 2017; 57 (08) 1195-1205
- 17 Bidot S, Bruce BB, Saindane AM, Newman NJ, Biousse V. Asymmetric papilledema in idiopathic intracranial hypertension. J Neuroophthalmol 2015; 35 (01) 31-36
- 18 Wall M, Thurtell MJ. NORDIC Idiopathic Intracranial Hypertension Study Group. Optic disc haemorrhages at baseline as a risk factor for poor outcome in the idiopathic intracranial hypertension treatment trial. Br J Ophthalmol 2017; 101 (09) 1256-1260
- 19 Bidot S, Saindane AM, Peragallo JH, Bruce BB, Newman NJ, Biousse V. Brain imaging in idiopathic intracranial hypertension. J Neuroophthalmol 2015; 35 (04) 400-411
- 20 Albuquerque FC, Dashti SR, Hu YC. et al. Intracranial venous sinus stenting for benign intracranial hypertension: clinical indications, technique, and preliminary results. World Neurosurg 2011; 75 (5–6): 648-652 , discussion 592–595
- 21 Fargen KM, Liu K, Garner RM, Greeneway GP, Wolfe SQ, Crowley RW. Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting. J Neurointerv Surg 2018; 10 (12) 1203-1208
- 22 Durst CR, Ornan DA, Reardon MA. et al. Prevalence of dural venous sinus stenosis and hypoplasia in a generalized population. J Neurointerv Surg 2016; 8 (11) 1173-1177
- 23 Levitt MR, Hlubek RJ, Moon K. et al. Incidence and predictors of dural venous sinus pressure gradient in idiopathic intracranial hypertension and non-idiopathic intracranial hypertension headache patients: results from 164 cerebral venograms. J Neurosurg 2017; 126 (02) 347-353
- 24 Raper DMS, Buell TJ, Chen CJ, Ding D, Starke RM, Liu KC. Intracranial venous pressures under conscious sedation and general anesthesia. J Neurointerv Surg 2017; 9 (10) 986-989
- 25 Fargen KM, Spiotta AM, Hyer M. et al. Comparison of venous sinus manometry gradients obtained while awake and under general anesthesia before venous sinus stenting. J Neurointerv Surg 2017; 9 (10) 990-993
- 26 Case D, Seinfeld J, Roark C, Kumpe D. Idiopathic intracranial hypertension: contemporary management and endovascular techniques. Semin Intervent Radiol 2020; 37 (02) 175-181
- 27 Guo XB, Wei S, Guan S. Intracranial venous pressures manometry for patients with idiopathic intracranial hypertension: under awake setting or general anesthesia. Front Neurol 2019; 10: 751
- 28 Avery MB, Sambrano S, Khader Eliyas J, Eesa M, Mitha AP. Accuracy and precision of venous pressure measurements of endovascular microcatheters in the setting of dural venous sinus stenosis. J Neurointerv Surg 2018; 10 (04) 387-391
- 29 Wang S, Tong X, Li X. et al. Comparison of microcatheter and pressure wire for venous sinus manometric evaluation of patients with idiopathic intracranial hypertension. Interv Neuroradiol 2023; 29 (04) 408-412
- 30 Sinclair AJ, Burdon MA, Nightingale PG. et al. Low energy diet and intracranial pressure in women with idiopathic intracranial hypertension: prospective cohort study. BMJ 2010; 341: c2701
- 31 Newborg B. Pseudotumor cerebri treated by rice reduction diet. Arch Intern Med 1974; 133 (05) 802-807
- 32 Wong R, Madill SA, Pandey P, Riordan-Eva P. Idiopathic intracranial hypertension: the association between weight loss and the requirement for systemic treatment. BMC Ophthalmol 2007; 7: 15
- 33 Çelebisoy N, Gökçay F, Şirin H, Akyürekli O. Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study. Acta Neurol Scand 2007; 116 (05) 322-327
- 34 Mula M. Topiramate and cognitive impairment: evidence and clinical implications. Ther Adv Drug Saf 2012; 3 (06) 279-289
- 35 Thambisetty M, Lavin PJ, Newman NJ, Biousse V. Fulminant idiopathic intracranial hypertension. Neurology 2007; 68 (03) 229-232
- 36 Sioutas GS, Mualem W, Reavey-Cantwell J, Rivet II DJ. GLP-1 receptor agonists in idiopathic intracranial hypertension. JAMA Neurol 2025; 82 (09) 887-894
- 37 Sinclair AJ, Kuruvath S, Sen D, Nightingale PG, Burdon MA, Flint G. Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review. Cephalalgia 2011; 31 (16) 1627-1633
- 38 Abubaker K, Ali Z, Raza K, Bolger C, Rawluk D, O'Brien D. Idiopathic intracranial hypertension: lumboperitoneal shunts versus ventriculoperitoneal shunts–case series and literature review. Br J Neurosurg 2011; 25 (01) 94-99
- 39 Starks V, Gilliland G, Vrcek I, Gilliland C. Effect of optic nerve sheath fenestration for idiopathic intracranial hypertension on retinal nerve fiber layer thickness. Orbit 2016; 35 (02) 87-90
- 40 Feldon SE. Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension. Neurosurg Focus 2007; 23 (05) E6
- 41 Alsuhaibani AH, Carter KD, Nerad JA, Lee AG. Effect of optic nerve sheath fenestration on papilledema of the operated and the contralateral nonoperated eyes in idiopathic intracranial hypertension. Ophthalmology 2011; 118 (02) 412-414
- 42 Chandrasekaran S, McCluskey P, Minassian D, Assaad N. Visual outcomes for optic nerve sheath fenestration in pseudotumour cerebri and related conditions. Clin Exp Ophthalmol 2006; 34 (07) 661-665
- 43 Fridley J, Foroozan R, Sherman V, Brandt ML, Yoshor D. Bariatric surgery for the treatment of idiopathic intracranial hypertension. J Neurosurg 2011; 114 (01) 34-39
- 44 Fields JD, Javedani PP, Falardeau J. et al. Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension. J Neurointerv Surg 2013; 5 (01) 62-68
- 45 Higgins JNP, Cousins C, Owler BK, Sarkies N, Pickard JD. Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry 2003; 74 (12) 1662-1666
- 46 Dinkin MJ, Patsalides A. Idiopathic intracranial venous hypertension: toward a better understanding of venous stenosis and the role of stenting in idiopathic intracranial hypertension. J Neuroophthalmol 2023; 43 (04) 451-463
- 47 Ahmed RM, Wilkinson M, Parker GD. et al. Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. AJNR Am J Neuroradiol 2011; 32 (08) 1408-1414
- 48 Puffer RC, Mustafa W, Lanzino G. Venous sinus stenting for idiopathic intracranial hypertension: a review of the literature. J Neurointerv Surg 2013; 5 (05) 483-486
- 49 Fargen KM. Venous stenting for idiopathic intracranial hypertension: lessons learned from a high-volume practice. J NeuroInterventional Surg 2022; 14 (06) 528-532
- 50 Paniccia R, Priora R, Liotta AA, Abbate R. Platelet function tests: a comparative review. Vasc Health Risk Manag 2015; 11: 133-148
- 51 Kalyvas AV, 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 (01) 33-49
- 52 Dinkin MJ, Patsalides A. Venous sinus stenting in idiopathic intracranial hypertension: results of a prospective trial. J Neuroophthalmol 2017; 37 (02) 113-121

