BACKGROUND AND PURPOSE:In medically refractory idiopathic intracranial hypertension, optic nerve sheath fenestration or CSF shunting is considered the next line of management. Venous sinus stenosis has been increasingly recognized as a treatable cause of elevated intracranial pressure in a subset of patients. In this article, we present the results of the largest meta-analysis of optic nerve sheath fenestration, CSF shunting, and dural venous sinus stenting. This is the only article that compares these procedures, to our knowledge.

Purpose of review Negative findings on neuroimaging are part of the diagnostic criteria for idiopathic intracranial hypertension (IIH), a syndrome characterized by increased intracranial pressure (ICP). Some positive neuroimaging findings are associated with increased ICP, but their role in diagnosis of IIH has not been established. We provide an overview of these findings and their relevance for diagnosis of raised intracranial pressure. Recent findings MRI acquisition techniques have significantly improved in the last few decades leading to better characterization of the intracranial changes associated with IIH, including empty sella turcica, optic nerve tortuosity, distension of the optic nerve sheath, posterior globe flattening, slit-like ventricles, and venous sinus stenosis. These may be MRI biomarkers of increased ICP. Prevalence difference between people with and without increased ICP, and reversibility of these MRI findings following treatment of increased ICP inform evaluation of their diagnostic potential. Summary MRI and magnetic resonance venography findings are important tools in the diagnosis of IIH. Empty sella turcica, optic nerve protrusion, distension of the optic nerve sheath, optic nerve tortuosity, posterior globe flattening, and transverse sinus stenosis have been found to be the most promising diagnostic markers for IIH, although absence of these findings does not rule out the diagnosis.

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Objective-This report presents final 2010 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends by selected characteristics such as age, sex, Hispanic origin, race, state of residence, and cause of death.Methods-Information reported on death certificates, which is completed by funeral directors, attending physicians, medical exam iners, and coroners, is presented in descriptive tabulations. The original records are filed in state registration offices. Statistical infor mation is compiled in a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Pre vention's National Center for Health Statistics. Causes of death are processed in accordance with the International Classification of Dis eases, Tenth Revision.Results-In 2010, a total of 2,468,435 deaths were reported in the United States. The age-adjusted death rate was 747.0 deaths per 100,000 standard population, lower than the 2009 rate (749.6) and a record low rate. Life expectancy at birth rose 0.2 year, from 78.5 years in 2009 to a record high of 78.7 in 2010. Age-specific death rates decreased for each age group under 85, although the decrease for ages 1-4 was not significant. The age-specific rate increased for ages 85 and over. The leading causes of death in 2010 remained the same as in 2009 for all but one of the 15 leading causes. Pneumonitis due to solids and liquids replaced Assault (homicide) as the 15th leading cause of death in 2010. The infant mortality rate decreased 3.8% to a historically low value of 6.15 deaths per 1,000 live births in 2010.Conclusions-The decline of the age-adjusted death rate to a record low value for the United States, and the increase in life expectancy to a record high value of 78.7 years, are consistent with long-term trends in mortality. Keywords: mortality • cause of death • life expectancy • vital statistics Highlights Mortality experience in 2010• In 2010, a total of 2,468,435 resident deaths were registered in the United States.• The age-adjusted death rate, which accounts for the aging of the population, was 747.0 deaths per 100,000 U.S. standard popu lation.• Life expectancy at birth was 78.7 years.• The 15 leading causes of death in 2010 were:1. Diseases of heart (heart disease) 2. Malignant neoplasms (cancer) 3. Chronic lower respiratory diseases 4. Cerebrovascular diseases (stroke) 5. Accidents (unintentional injuries) 6. Alzheimer's disease 7. Diabetes mellitus (diabetes) 8. Nephritis, nephrotic syndrome and nephrosis (kidney disease) 9. Influenza and pneumonia 10. Intentional self-harm (suicide) 11. Septicemia 12. Chronic liver disease and cirrhosis 13. Essential hypertension and hypertensive renal dis ease (hypertension) 14. Parkinson's disease 15. Pneumonitis due to solids and liquids• In 2010, the infant mortality rate was 6.15 infant deaths per 1,000 live births.• The 10 leading causes of infant death were:1. Congenital malformations, deformations and chromo somal abnormalities (congenital malformations) 2. Disorders rela...

Background Idiopathic intracranial hypertension (IIH) is a syndrome defined by elevated intracranial hypertension without radiographic evidence of a mass lesion in the brain. Dural venous sinus stenosis has been increasingly recognized as a treatable cause, and dural venous sinus stenting (DVSS) is increasingly performed. Methods A 5 year single-center retrospective analysis of consecutive patients undergoing DVSS for medically refractory IIH. Results There were 43 patients with a mean imaging follow-up of 6.5 months and a mean clinical follow-up period of 13.5 months. DVSS was performed as the first procedure for medically refractory IIH in 81.4% of patients, whereas 18.6% of patients included had previously had a surgical procedure (ventriculoperitoneal (VP) shunt or optic nerve sheath fenestration (ONSF)). Headache was present in all patients and after DVSS improved or remained stable in 69.2% and 30.8%, respectively. Visual acuity changes and visual field changes were present in 88.4% and 37.2% of patients, respectively. Visual field improved or remained unchanged in 92%, but worsened in 8% after stenting. There was a stent patency rate of 81.8%, with an 18.2% re-stenosis rate. Of the 43 procedures performed, there was a 100% technical success rate with zero major or minor complications. Conclusion Based on this single-center retrospective analysis, DVSS can be performed with high technical success and low complication rates. A majority of patients presented primarily with headache, and these patients had excellent symptom relief with DVSS alone. Patients presenting with visual symptoms had lower success rates, and this population, if stented, should be carefully followed for progression of symptoms.