Efficacy of endovascular stenting in dural venous sinus stenosis for the treatment of idiopathic intracranial hypertension

Abstract

<jats:p>Multiple pathophysiological mechanisms have been proposed for the increased intracranial pressure observed in idiopathic intracranial hypertension (IIH). The condition is well characterized, with intractable headaches, visual obscurations, and papilledema as dominant features, mainly affecting obese women. With the advent of MR venography and increased use of cerebral angiography, there has been recent emphasis on the significant number of patients with IIH found to have associated nonthrombotic dural venous sinus stenosis. This has led to a renewed interest in endovascular stenting as a treatment for IIH. However, the assumption that venous stenosis leads to a high pressure gradient that decreases CSF resorption through arachnoid villi requires further evidence. In this paper, the authors analyze the published results to date of dural venous sinus stenting in patients with IIH. They also present a case from their institution for illustration. The pathophysiological mechanism in IIH requires further elucidation, but venous sinus stenosis with subsequent intracranial hypertension appears to be an important mechanism in at least a subgroup of patients with IIH. Among these patients, 78% had complete relief or improvement of their main presenting symptoms after endovascular stenting. Resolution or improvement in papilledema was seen in 85.1% of patients. Endovascular stenting should be considered whenever venous sinus stenosis is diagnosed in patients with IIH.</jats:p>

Venous sinus stenting is a valuable treatment for fulminant idiopathic intracranial hypertension

“…Although there is still debate as to whether or not transverse sinus stenosis leads to elevated ICP by causing venous hypertension and decreased CSF absorption or results from elevated ICP causing external compression of the vessel [11], it has been proposed that there may be a cycle where both of these mechanisms play a role [12]. Despite this controversy, the results reported for patients stented for transverse sinus stenosis have been promising [13][14][15][16][17][18][19]. For instance, in the largest reported series by Ahmed et al [20] all 52 patients treated with stenting had reversal of papilledema and normalized venous pressures, headaches were resolved in 49/52 patients, and 12% of patients required revision of the stent during the mean 2 year follow-up period.…”

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“…Based on this data, a growing number of studies investigating this topic have been conducted, in which the vast majority of patients were women. 13,19,22 In a recent review, a group of Canadian researchers reviewed 8 studies and analyzed a total of 40 patients treated using the method. 26 After stenting, 82.5% of the patients showed resolution or significant improvement of their headaches, and 91% of individuals exhibiting papilledema upon admission showed an improvement of this sign.…”

The cerebral venous circulation and headache

“…Il demeure toujours un questionnement sur l'origine primitive ou secondaire [14] des sténoses des sinus transverses ayant abouti au célèbre éditorial de Corbett et Digre dans Neurology [6]. Les arguments pour l'une et l'autre de ces hypothèses sont parfaitement résumés dans l'article d'Arac et al [2]. La solution viendra peut-être des modèles mathé-matiques récemment développés dont le séduisant modèle de Bateman et al [3].…”