Pressure Challenges: the journey of idiopathic intracranial hypertension management from past to future. A narrative review of treatment options in obesity patients

Desafios de Pressão: a jornada do tratamento da hipertensão intracraniana idiopática do passado ao futuro. Uma revisão narrativa das opções de tratamento em pacientes com obesidade

• Felipe Salvagni Pereira    
• Bruna Bastiani    
• Kim Wouters    
• Leonardo Pinto Amancio    
• Enzo von Quednow    
• Khalil St Brice    
• Luis Gustavo Biondi Soares    
• Anais Concepcion Marinho Andrade de Moura
• Amylcar Dvilevicius
• Gustavo Rassier Isolan

• https://doi.org/10.22290/jbnc.2026.08121535
• J Bras Neurocirur 37 (2):219-225, 2026

Resumo

A hipertensão intracraniana idiopática (HII), ou pseudotumor cerebral, é caracterizada por pressão intracraniana elevada com líquido cefalorraquidiano normal, levando a cefaleia, papiledema e possível perda visual. Esta revisão destaca a perda ponderal como uma estratégia no manejo da doença, devido à sua forte relação com melhora sintomatológica e redução da pressão intracraniana. Uma busca em bases de dados identificou 269 estudos, dos quais sete revisões sistemáticas foram selecionadas para análise. As evidências mostram que a perda ponderal é fundamental para o tratamento. Dietas de baixa caloria podem gerar resultados rápidos inicialmente, mas o sucesso a longo prazo exige acompanhamento contínuo. Abordagens multicomponentes — combinando restrição calórica e atividade física regular — oferecem benefícios mais duradouros. A cirurgia bariátrica proporciona a maior e mais sustentada perda de peso, especialmente em casos de obesidade grave, reduzindo significativamente o IMC e melhorando os desfechos. Estratégias não cirúrgicas continuam relevantes para obesidade leve ou quando a cirurgia é contra-indicada. Agonistas do receptor GLP-1, também mostram potencial ao promover perda ponderal e aliviar sintomas. Assim, um plano integrado para manejo do controle de peso é essencial para melhorar a qualidade de vida na HII. 

Palavras-chave

Hipertensão intracraniana idiopática; Pseudotumor; Tratamento; Obesidade; Qualidade de vida

Abstract

Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is characterized by elevated intracranial pressure with normal cerebrospinal fluid, leading to headaches, papilledema, and potential vision loss. This review focuses on weight loss as a central management strategy due to its strong link to symptom improvement and reduced ICP. A database search identified 269 studies, and seven systematic reviews were selected for analysis. Evidence shows that weight reduction is fundamental for treatment. Very low-energy diets can produce rapid early results, but long-term success requires ongoing guidance. Multicomponent approaches—combining calorie restriction with regular physical activity—yield more sustained benefits. Bariatric surgery offers the greatest and most durable weight loss, particularly in severe obesity, significantly reducing BMI and improving outcomes. Non-surgical strategies remain relevant for mild obesity or patients unable to undergo surgery. GLP-1 receptor agonists, such as semaglutide, also appear promising by enhancing weight loss and relieving headaches. An integrated, long-term weight management plan is essential for better quality of life in IIH.

Keywords

Idiopathic intracranial hypertension; Pseudotumor; Treatment; Obesity; Quality of life

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1Principles of Surgery, Department of Post-Graduation, Mackenzie Evangelical College of Parana, Curitiba, PR, Brazil.

2Department of Anesthesiology, Federal University of Parana, Curitiba, PR, Brazil.

3Open University, Faculty of Psychology, Heerle, Nederlands.

4Department of Neurosurgery, Hospital Angelina Caron, Curitiba, PR, Brazil.

5Department of Clinical Neurophysiology, Hospital Universitaria Sant Joan de Reus, Reus, Spain.

6Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad.

7Department of Neurosurgery, Santa Casa de Montes Claros, Montes Claros, MG, Brazil.

8University at Buffalo, NY, USA.

9Neurology and Neurosurgery Advanced Center – CEANNE, Porto Alegre, RS, Brazil.

 

Received Sep 6, 2025

Accepted Sep 30, 2025