Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is characterized by elevated intracranial pressure (>25 cm H2O) without an identifiable cause, most common in obese women of reproductive age. Patients typically present with headaches, papilledema, tinnitus, and visual disturbances that may lead to vision loss. Treatment includes lifestyle modification, medical therapy, and surgical interventions such as CSF shunting, venous sinus stenting, optic nerve sheath fenestration, and bariatric surgery, each with varying efficacy and complication rates.

A comprehensive search was performed across PubMed, Web of Science, Cochrane, and Scopus up to March 5, 2024, to identify studies evaluating surgical interventions for IIH. Data on clinical outcomes and complications were extracted and pooled for analysis.

From 119 pooled studies, there were 2561 CSF-diversion cases, 888 dural venous stent placements,1189 ONSF procedures and 249 Bariatric surgery. Postoperative improvement rates were as follows: headaches (CSF vs.VSS vs. ONSF vs. Bariatric surgery: 38% vs. 47% vs. 36% vs. 14%), papilledema (39% vs. 25% vs.10% vs. 14%), tinnitus (27% vs. 27% vs. 14%), visual field defect (32% vs. 43% vs. 33% vs. 72%), whilst visual acuity changes favored Bariatric surgery (33% vs. 57% vs. 31% vs.71%). There was a significantly lower rate of subsequent procedures with Bariatric surgery (39% vs. 5% vs. 23% vs. 0%), minor complication rates were (13% vs. 1% vs. 15% vs. 1%) and major complication rates were (11% vs.1% vs. 1% vs. 1%).

Dural venous sinus stenting and bariatric surgery showed superior outcomes and lower complication rates compared to traditional surgical options, suggesting they may represent the most effective interventions for patients with medically refractory IIH.