Idiopathic intracranial hypertension denotes raised intracranial pressure in the absence of an identifiable cause and presents with symptoms relating to elevated ICP, namely headaches and visual deterioration. Treatment of IIH aims at reducing intracranial pressure, relieving headache and salvaging patients' vision. Surgical interventions are recommended for medically refractory IIH and include CSF diversion techniques, optic nerve sheath fenestration, bariatric surgery and venous sinus stenting. Prospective studies on the surgical options for IIH are scant and no evidence-based guidelines for the surgical management of medically refractory IIH have been established. A search in Cochrane Library, MEDLINE and EMBASE from 1 January 1985 to 19 April 2019 for controlled or observational studies on the surgical treatment of IIH (defined in accordance with the modified Dandy or the modified Friedman criteria) in adults yielded 109 admissible studies. VSS improved papilledema, visual fields and headaches in 87.1%, 72.7% and 72.1% of the patients respectively, with a 2.3% severe complication rate and 11.3% failure rate. CSF diversion techniques diminished papilledema, visual field deterioration and headaches in 78.9%, 66.8% and 69.8% of the cases and are associated with a 9.4 severe complication rate and a 43.4% failure rate. ONSF ameliorated papilledema, visual field defects and headaches in 90.5, 65.2% and 49.3% of patients. Severe complication rate was 2.2% and failure rate was 9.4%. This is currently the largest systematic review for the available operative modalities for IIH. VSS provided the best results in headache resolution and visual outcomes, with low failure rates and a very favourable complication profile. In light of this, VSS ought to be regarded as the first-line surgical modality for the treatment of medically refractory IIH.

中文翻译：

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对特发性颅内高压（IIH）外科治疗的系统评价。

特发性颅内高压是指在没有明确原因的情况下颅内压升高，并表现出与ICP升高有关的症状，即头痛和视力下降。IIH的治疗旨在降低颅内压，缓解头痛并挽救患者的视力。建议对难治性IIH采取外科手术干预措施，包括CSF转移技术，视神经鞘窗开窗术，减肥手术和静脉窦支架置入术。关于IIH手术选择的前瞻性研究很少，并且尚未建立基于证据的难治性IIH手术管理指南。在Cochrane图书馆中进行搜索，1985年1月1日至2019年4月19日进行的MEDLINE和EMBASE用于成人IIH手术治疗的对照或观察性研究（根据修改的Dandy或修改的Friedman标准定义）产生了109项可接受的研究。VSS分别改善了87.1％，72.7％和72.1％的患者的乳头水肿，视野和头痛，严重并发症发生率2.3％，失败率11.3％。脑脊液转移技术可减少78.9％，66.8％和69.8％的乳头水肿，视野恶化和头痛，并伴有9.4例严重并发症发生率和43.4％失败率。ONSF改善了90.5％，65.2％和49.3％的患者的乳头水肿，视野缺损和头痛。严重并发症发生率为2.2％，失败率为9.4％。目前，这是对IIH可用手术方式的最大的系统评价。VSS在缓解头痛和视觉效果方面提供了最佳结果，失败率低且并发症非常有利。有鉴于此，VSS应该被视为治疗难治性IIH的一线手术方式。