A 16-year-and-6-month-old severely obese boy [weight: 133.6 kg; height: 1.74 m (+0.14 standard deviation — SD); BMI: 44.1 kg/m2 (+4.4 SD)], Tanner pubertal stage 5, followed for obesity due to excess energy intake in our Pediatric Endocrinology Clinic since he was eight years old, and with a history of severe obstructive sleep apnea, gastrointestinal reflux disease, depression, insulin resistance (HOMA-IR 9.8), moderate hepatic steatosis [based on ultrasound findings and ALT: 41 U/L (reference value: <40 U/L)], and systemic arterial hypertension with cardiac left ventricular hypertrophy, presented biparietal, high-intensity, and pulsatile headaches. The headaches had progressively worsened over the prior three months. They occurred five times per week and were associated with nocturnal awakenings. There was partial improvement with common analgesics. He was not able to stand still or walk straight without falling during the headache episodes. Ophthalmologic evaluation confirmed bilateral papilledema (), normal visual acuity, and absence of abducens nerve palsy. Cranial computed tomography revealed no mass or anatomic abnormalities. Lumbar puncture showed increased intracranial pressure of 40 cmH2O (reference value: <28 cmH2O) with a normal content. Optical coherence tomography (OCT) was not performed. IIH was diagnosed. The patient was started on acetazolamide q12h with partial improvement of his symptoms. However, after three months, he was still symptomatic. As he had already failed to lose weight after being enrolled in a medically supervised weight-loss program (composed of a multidisciplinary team including a nutritionist, physical therapist, psychologist, and pediatric surgeon specialized in bariatric surgery), and exhibited a bone age of a 17-year-old, we indicated bariatric surgery. During this period, he and his family were encouraged to make lifestyle changes (healthy diet and physical activity). They were also followed monthly by a psychologist. The patient was treated with sibutramine, fluoxetine, and metformin, but showed no response. Our decision was taken after considering the criteria established by the Brazilian Federal Council of Medicine guidelines to undergo bariatric surgery in adolescence, which the patient fulfilled. The family formally consented, and the patient assented to the procedure. At the age of 16 years and nine months, the patient underwent an uncomplicated laparoscopic sleeve gastrectomy. Ophthalmologic evaluation, performed five months after surgery, revealed normal visual acuity in both eyes and improvement of bilateral papilledema. Follow-up at 18 months showed a 67.5% loss of excess weight (weight: 94.5 kg and BMI: 31.2 kg/m2) and complete resolution of IIH symptoms. Insulin resistance (HOMA-IR: 2.4) and hepatic steatosis normalized, and antihypertensive drugs were no longer needed.