Endovascular treatment of idiopathic intracranial hypertension

Abstract

The importance of venous sinus disease in the etiology of idiopathic intracranial hypertension is probably underestimated. Patients with idiopathic intracranial hypertension in whom a venous sinus stenosis is demonstrated by a noninvasive radiologic workup should be evaluated with direct retrograde cerebral venography and manometry. In patients with a lesion of the venous sinuses who experienced medical treatment failure, endovascular stent placement seems to be an interesting alternative to classic surgical approaches.

Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions

“…Our group 22 reported 4 patients with stented IIH; headache improved in all 4 and vision, in 3. Donnet et al 23 reported 10 patients with IIH, stented without complication; 6 were cured and 4 improved. Bussiere et al 24 reported 10 patients with IIH stented, with resolution of venous hypertension in all and symptom improvement in most.…”

“…[17][18][19][20][21][22][23][24] In the past 9 years, we have stented 1 transverse sinus in 52 patients with IIH with transverse sinus stenosis who either failed medical treatment or had fulminant visual loss. We reviewed the data; on the basis of a mathematic model 25 that incorporates a collapsible transverse sinus as a Starling-like resistor (one in which the resistance is a linear function of pressure external to the resistor lumen), we attempted to reconcile opposing views of transverse sinus stenosis as a cause and a consequence of intracranial hypertension.…”

Idiopathic Intracranial Hypertension: Diagnostic Accuracy of the Transverse Dural Venous Sinus Attenuation on CT Scans

“…Bilateral narrowing of the transverse sinus (TS) without associated thrombosis is a common finding among patients with IIH [31][32][33][34][35] . One theory is that the stenosis causes IIH.…”

“…by the fact that stent angioplasty can help control intracranial hypertension (IH) in some patients 33,34,[42][43][44] . However, lowering the intracranial pressure can result in normalization of venous morphology, suggesting TS stenosis might be induced by IH itself (secondary cranial venous outflow obstruction (CVOO)) 36,37 .…”

Neuroimaging - Clinical Applications

“…Based on the frequent findings in MRI venography of narrowed transverse sinuses, endovascular stenting of the venous sinuses has been recently advocated by some authors (Higgins et al, 2002;Higgins et al, 2003;Metellus et al, 2005;Metellus et al, 2007;Donnet et al, 2008;Paquet et al, 2008). Higgins et al (2002) was the first to report on a 30 year old patient with refractory PTC, papilledema and bilateral TS stenosis found on an MR venogram, that was successfully treated with dilation of 1 of the sinuses with a stent, thus reducing the pressure gradient with dramatic symptomatic improvement.…”