Endovascular stenting for idiopathic intracranial hypertension with venous sinus stenosis

Abstract

Objectives Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure of unknown etiology and venous sinus stenting may be an optional treatment. We aimed to evaluate the effects of venous sinus stenting on visual function, intracranial pressure, and trans‐stenotic pressure gradient of the patients with IIH and to determine effects of baseline BMI or weight changes on subjective vision outcome and intracranial pressure. Methods From July 2009 to Aug 2016, 88 eligible patients with IIH and venous sinus stenosis who underwent stenting were retrospectively studied. Results In this study, 67 women and 21 men were included with an average age of 39.01 (18–60) years. The average BMI was 26.75 kg/m 2 . Here, 66 (75.9%) patients had papilledema, 39 had impaired vision before stenting; 57 patients were followed‐up, 48 (84.2%) showed significant subjective improvement or recovery in visual acuity, 4 (7.0%) patients reported no significant change in visual functions, and 5 (8.8%) suffered permanent vision loss. The cerebrospinal fluid opening pressure and trans‐stenotic pressure gradient were significantly decreased postoperatively. Baseline BMI was associated with pre‐and postoperative trans‐stenotic pressure gradients, as well as changes in cerebrospinal fluid opening pressure. However, baseline BMI and body weight changes during follow‐up were not necessarily associated with subjective visual outcomes after stenting. Stenting efficacy was limited in patients with severe preoperative optic symptoms. Conclusions Venous sinus stenting represented an effective treatment for resolving visual dysfunction and intracranial pressure associated with venous sinus stenosis. BMI seemed to be associated with intracranial pressure but not subjective visual outcomes after stenting.

Improved Ophthalmic Outcomes Following Venous Sinus Stenting in Idiopathic Intracranial Hypertension

“…While improvements were also noted in a portion of our patients for BCVA and mean deviation, a smaller percentage met preset criteria for meaningful improvement than in most prior studies. For example, the 2019 Liu et al study found 84.2% of patients reported significant improvement or recovery in their visual acuity (20). The difference is probably explained by baseline differences between the study population, as the baseline visual field mean deviation in the worse eye was −16.3 dB in the Liu et al study compared to a baseline visual field mean deviation of only −4.90 dB in our study.…”

Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension—From Physiopathology to Treatment

“…The clinical outcomes of dural sinus stenting are related to headache, but especially improvement of visual parameters (visual acuity, papilledema), and as a secondary achievement, the improvement or disappearance of the tinnitus. In the published meta-analysis and retrospective reviews of case series ( Table 1 ), there was a consistent benefit with respect to these parameters: headache subsided or was significantly improved in 73–93% of patients, papilledema in 68–100%, visual acuity and visual field improvement in 70.3–86.5%, and tinnitus in 84.5–100% of patients [ 57 , 61 , 65 , 70 , 71 , 72 , 73 ].…”

Men Are from Mars, Idiopathic Intracranial Hypertension Is from Venous: The Role of Venous Sinus Stenosis and Stenting in Idiopathic Intracranial Hypertension

“…Quantitative assessment of visual field loss was possible for 82 patients (163 eyes) before and after stenting based on five studies that reported mean deviations. 34,38,46,52,62 Among these 163 eyes, the average mean deviation was À12.83 dB prior to stenting and improved to À7.53 dB poststenting.…”

“…Quantitative assessment of prestent ICP was reported in 461 patients (mean: 35.3 cm H 2 O) and poststent ICP was reported in 196 patients (mean: 19.5 cm H 2 O). 46,51 The difference between mean pre-and poststent ICP was 16 cm H 2 O, but this must be understood with the caveat that the sample sizes in the two groups differed. Data on long-term (>1-year poststent) opening pressure is scarce, since repeat LPs are generally performed only in patients who are not doing well clinically.…”