Scientists are looking for the best surgery to prevent blindness

Idiopathic intracranial hypertension (IIH) increases intracranial pressure around the brain and causes blindness. Scientists are not sure what causes IIH, because the pressure builds up without the presence of tumour or disease. As the mechanism is unknown treatment for IIH is not yet developed.

But now researchers at the University of Birmingham are leading a clinical trial that could identify the best surgical treatment option to prevent blindness in patients with IIH.

Ultrasound of the optic nerve showing IIH. IIH increases intracranial pressure around the brain without tumours or similar conditions. Image credit: Ben Smith via Wikimedia (CC BY-SA 4.0)

IIH is a relatively uncommon condition. It is usually associated with a higher weight. In fact, IIH can be managed by losing weight. Symptoms include headaches, pulsatile tinnitus, back and neck pains and, of course, visual loss. There are some medications available. However, if left untreated IIH can lead to blindness, which can sometimes be prevented with dural venous sinus stenting or cerebrospinal fluid surgeries. Which one of these two surgeries is the best option? Scientists simply don’t know – there are no studies in this area.

And that is what scientists will do now. They have up to 138 IIH patients with rapid vision deterioration participating in this study. Researchers will attempt to determine which surgical procedure is the best at saving vision, safest, causes the smallest number of complications and is the most cost effective. Philip White,Co-Investigator of the study, said: “So far, studies have not provided high quality evidence to show that this procedure can prevent blindness when vision is rapidly declining. Additionally, we need to confirm procedural durability compared with the surgery, which may need to be repeated and establish its safety is at least comparable.”

Both procedures have their advantages and disadvantages. Cerebrospinal fluid shunting involves implanting a shunt into the brain and draining excess cerebrospinal fluid flow to another part of the body. This does work, but almost always within a year the shunt becomes blocked or infected. So far stenting, which is a more recent procedure, seems more promising, but data is lacking and scientists are not sure whether that is actually the best way to go.

Although in the beginning of the article we said that IIH is not a common condition, it is not exactly rare either. It occurs in about one per 100,000 people. Overweight people are affected more often, but IIH can bother both children and adults. IIH is way more common among women. It is very important to find the most effective treatment, because people are losing their vision, which is a huge impairment on the quality of life.


Source: University of Birmingham