Idiopathic Intracranial Hypertension (IIH)

Intervention To Preserve Vision In Idiopathic Intracranial Hypertension: Evaluation Of Clinical Effectiveness And Cost Effectiveness

Addressing priority 10: NIHR research in progress

In IIH patients with rapidly declining vision a surgical procedure is needed to reduce brain pressure (intracranial pressure or ICP) to try to prevent blindness. But there have been no clinicals trial to determine the best surgical operation. Usually, ICP can be quickly reduced by a surgical procedure called a Cerebrospinal Fluid (CSF) shunt. This involves a thin tube (shunt) being implanted in the brain. The excess CSF in the brain flows through the shunt to another part of the body, usually the abdomen. From here, it's absorbed into the blood. Low quality evidence has shown that it is effective at preventing blindness in most patients. However, within the first year after placement many shunts fail (e.g. get blocked or infected). This and other complications have a significant impact on patients and have important cost implications for the NHS. More recently, a procedure called Dural Vein Stenosis Stenting (DVSS) has been used. This involves a small tube (stent) placed across a narrowing (stenosis) of certain blood vessels in the brain. This improves blood flow and can lower ICP. So far, studies have not provided high quality evidence to show that this procedure can prevent blindness when vision is rapidly declining. Additionally, this procedure can also cause complications and require repeating. These types of surgery have not been compared in an appropriately design study. This trial will establish which of the surgical procedures is the best at saving vision, the safest with least complications and which is the most cost effective.

5-year programme of work into IIH and new treatments

Addressing the top 3 priorities: Research underway funded by the Sir Jules Thorne Charitable Trust