Outcomes of Bariatric Surgery for Idiopathic Intracranial Hypertension: A Systematic Review and a Single-Arm Meta-analysis.

BACKGROUND AND

aimsIdiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure (ICP) in the absence of structural pathology and is strongly linked to obesity. Weight reduction remains the only disease-modifying therapy, and bariatric surgery (BS) may offer durable ICP control and symptom improvement. This study evaluated postoperative clinical, visual, and physiological outcomes in patients with IIH undergoing BS.

methodsA systematic review and single-arm meta-analysis were conducted in accordance with PRISMA and Cochrane guidelines. PubMed, Embase, and CENTRAL were searched through April 2025. Eligible studies included obese patients with IIH who underwent any bariatric procedure. Primary outcomes were remission of headache, papilledema, pulsatile tinnitus, and cessation of IIH-related medications. Secondary outcomes included changes in visual parameters, weight loss, BMI reduction, and CSF opening pressure. Risk of bias was assessed with ROBINS-I for observational studies and RoB-2 for randomized trials. Heterogeneity was explored through leave-one-out analyses, Baujat influence plots, and meta-regression.

resultsNine studies (eight observational, one randomized clinical trial) comprising 229 patients were included. Patients were predominantly women with severe obesity (BMI 40.4-49.0 kg/m²) and markedly elevated baseline CSF pressures (32-45 cmH₂O). Pooled estimates demonstrated high rates of improvement across outcomes, including headache (84.6%), visual field deficits (83.3%), pulsatile tinnitus (88.7%), and visual symptoms (98.1%). Papilledema resolution approached 98% but showed wide prediction intervals due to small samples and complete-event studies. Medication cessation occurred in 63.3% of patients. CSF pressure decreased significantly (mean - 13.24 cmH₂O), and total weight loss averaged 28.5%, with excess weight loss of 65.7%. Meta-regression indicated that higher baseline CSF pressure and higher proportions of RYGB predicted greater CSF reduction, while preoperative BMI and the proportion of SG significantly moderated postoperative weight loss. Influence diagnostics identified Wills et al. and Lainas et al. as key contributors to heterogeneity in symptom and medication outcomes, and Mollan et al. as the principal driver of variability in weight-loss estimates. Reported complications were infrequent and predominantly mild, and no deaths were noted, although follow-up completeness varied. Risk of bias was low in the randomized trial but moderate to serious in the observational cohorts.

conclusionBariatric surgery in patients with IIH is associated with favorable postoperative outcomes, including high rates of symptom improvement and reduced medication use. While these findings support the potential disease-modifying role of surgical weight loss, they should be interpreted with caution given the single-arm nature of the available evidence and the predominance of observational studies.