Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting

Abstract

Background: The high pressures documented in the intracranial venous sinuses in idiopathic intracranial hypertension (IIH) could be the result of focal stenotic lesions in the lateral sinuses obstructing cranial venous outflow. Objective: To explore the relation between venous sinus disease and IIH. Methods: 12 patients with refractory IIH had dilatation and stenting of the venous sinuses after venography and manometry had shown intracranial venous hypertension proximal to stenoses in the lateral sinuses. Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome. Results: Intrasinus pressures were variably reduced by stenting. Five patients were rendered asymptomatic, two were improved, and five were unchanged. Conclusions: The importance of venous sinus disease in the aetiology of IIH is probably underestimated. Lateral sinus stenting shows promise as an alternative treatment to neurosurgical intervention in intractable cases.

Visual outcomes comparing surgical techniques for management of severe idiopathic intracranial hypertension

“…17,23,42 Based upon the concept that there is functional or actual stenosis of the intracranial venous outflow, intravascular stenting of the venous sinuses has been advocated as a yet another mode of treatment. 4,10,14,[18][19][20]24,33,34,36 Primary indications for the treatment of IIH are intractable headache and vision loss. Unfortunately, there are no evidence-based studies in which the risks and benefits of various interventions are assessed.…”

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 .…”

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“…27,28 In the present study, we decided to perform the procedure on one sinus only, electing the side with the highest pressure gradient. The rationale for this conduct is grounded in the pro-thrombotic properties of stents, in which a unilateral approach precludes the risk for the patient of future bilateral thrombosis of the transverse sinuses.…”