TY -的T1 -编者注:协会的体重的下降与颅内压减肥手术后女性特发性颅内高血压JF -神经学乔-神经病学SP - 542 LP - 542 - 10.1212 / WNL。半岛投注体育官网0000000000207118六世- 100 - 11 AU - James e . Siegler盟史蒂文Galetta Y1 - 2023/03/14 UR - //www.ebmtp.com半岛投注体育官网/content/100/11/542.1.abstract N2患者的多中心随机对照临床试验特发性颅内高血压(IIH), Mollan等人试图确定的重量损失必要实现生理缓解(颅内压(ICP)≤25厘米CSF)。研究者不仅发现更大的减肥,减肥手术实现了在社区体重管理但是病人手术经验的更大、更快速降低ICP。此外,仅在手术患者手臂实现下降ICP≤25厘米,这是与平均减肥从基线体重约24%。Ramsamy博士和他的同事强调手术并不是与视觉效果或显著改善头痛、颅内高压症的最严重症状。作为回应,Mollan博士和其coinvestigators注意研究的主要结果的证明治疗效果降低ICP(作为疾病缓解的生物标记),而不是次要结果关于视觉或其他颅内高压症的症状。说,调查人员承认仍没有共识定义在颅内高压症临床缓解。Brenner博士也评论的潜在辅助使用咖啡因减肥患者颅内高压症和视神经鞘开窗术的好处出现视力丧失。研究者引用原来的手稿发表在JAMA(神经学),据报道迅速而显著下降ICP在2周的减肥手术。半岛投注体育官网可能手术后急性荷尔蒙变化的快速增长等肠道神经肽glucagon-like peptide-1可能发挥了更大作用降低ICP比减肥。In their multicenter randomized controlled clinical trial of patients with idiopathic intracranial hypertension (IIH), Mollan et al. sought to determine the amount of weight loss necessary to achieve physiologic remission (intracranial pressure [ICP] ≤25 cm CSF). The investigators not only found that greater weight loss was achieved with bariatric surgery over community weight management but patients who underwent surgery experienced greater and more rapid reduction in ICP. Furthermore, only patients in the surgical arm achieved a fall in ICP to ≤25 cm, which was associated with a mean weight loss of approximately 24% from their baseline weight. Dr. Ramsamy and colleagues highlight that surgery was not associated with statistically significant improvement in visual outcomes or headache, which are the most disabling symptoms of IIH. In response, Dr. Mollan and their coinvestigators note the study was powered to demonstrate a treatment effect for the primary outcome of ICP reduction (as a biomarker of disease remission), rather than for secondary outcomes regarding visual or other symptoms of IIH. That said, the investigators admit there remains no consensus definition for clinical remission in IIH. Dr. Brenner also comments on the potential adjuvant use of caffeine in weight loss for patients with IIH and the benefits of optic nerve sheath fenestration when vision loss occurs. The investigators cite their original manuscript (published in JAMA Neurology), which reported a rapid and significant fall in ICP within 2 weeks of bariatric surgery. It is possible that acute hormonal changes after surgery such as a rapid rise in gut neuropeptide glucagon-like peptide-1 may have played a larger role in ICP reduction than weight loss alone. ER -