CSF dynamics issues related to bariatric surgery
EANS Academy. Bongetta D. 09/25/19; 275502; EP08002
Dr. Daniele Bongetta
Dr. Daniele Bongetta

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Abstract
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Introduction: Obesity has long been known to be a relevant risk factor for raised ICP and related conditions such as idiopathic intracranial hypertension and empty sella syndrome. Bariatric surgery (BS) is gaining popularity as the treatment of choice of morbid obesity, a condition constantly increasing over the last decades. Several complications have emerged as the number of surgeries and follow-up data increase. No systematic review of the neurosurgery-related potential complications has been performed to date.
Materials and methods: We reviewed literature for bariatric surgery-related complications involving the neurosurgical practice in the field of hydrocephalus and CSF dynamics. We also report explicative cases dealing with peri- and post-operative therapeutic precautions.
Results: Three pathological mechanisms emerged. The first is related to intracranial pressure raise during the actual bariatric procedure due to anaesthesiology issues and increased intraabdominal pressure for laparoscopic procedures. The second, in patients already treated with a CSF diversion, is related to the alteration of the pressure gradient across the shunting because of the diminishing of the abdominal pressure after BS, thus causing an over drainage syndrome. The third is the onset of a CSF fistula after BS because of both the variations of the epidural venous pressure and the deficiency of macro- and micro-nutrients which impair the dural collagen structure.
Conclusions: Neurosurgeons must be aware of the several, multifactorial neurosurgery-related complications of bariatric surgery as their prevalence is likely to be higher in the next years.
Introduction: Obesity has long been known to be a relevant risk factor for raised ICP and related conditions such as idiopathic intracranial hypertension and empty sella syndrome. Bariatric surgery (BS) is gaining popularity as the treatment of choice of morbid obesity, a condition constantly increasing over the last decades. Several complications have emerged as the number of surgeries and follow-up data increase. No systematic review of the neurosurgery-related potential complications has been performed to date.
Materials and methods: We reviewed literature for bariatric surgery-related complications involving the neurosurgical practice in the field of hydrocephalus and CSF dynamics. We also report explicative cases dealing with peri- and post-operative therapeutic precautions.
Results: Three pathological mechanisms emerged. The first is related to intracranial pressure raise during the actual bariatric procedure due to anaesthesiology issues and increased intraabdominal pressure for laparoscopic procedures. The second, in patients already treated with a CSF diversion, is related to the alteration of the pressure gradient across the shunting because of the diminishing of the abdominal pressure after BS, thus causing an over drainage syndrome. The third is the onset of a CSF fistula after BS because of both the variations of the epidural venous pressure and the deficiency of macro- and micro-nutrients which impair the dural collagen structure.
Conclusions: Neurosurgeons must be aware of the several, multifactorial neurosurgery-related complications of bariatric surgery as their prevalence is likely to be higher in the next years.
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