Major complications of dural venous sinus stenting for idiopathic intracranial hypertension: case series and management considerations

Abstract

BackgroundVenous sinus stenting (VSS) is a safe, effective, and increasingly popular treatment option for selected patients with idiopathic intracranial hypertension (IIH). Serious complications associated with VSS are rarely reported.MethodsSerious complications after VSS were identified retrospectively from multicenter databases. The cases are presented and management strategies are discussed.ResultsSix major acute and chronic complications after VSS were selected from a total of 811 VSS procedures and 1466 venograms for IIH. These included an acute subdural hematoma from venous extravasation, cases of both intraprocedural and delayed stent thrombosis, an ultimately fatal cerebellar hemorrhage resulting in acute obstructive hydrocephalus, venous microcatheter perforation during venography and manometry, and a patient who developed subarachnoid hemorrhage and subdural hematoma after cerebellar cortical vein perforation. The six cases are reviewed and learning points regarding complication avoidance and management are presented.ConclusionWe report on six rare, major complications after VSS for IIH. Familiarity with these potential complications and appropriate timely management may allow for good clinical outcomes.

A national survey of venous sinus stenting practices for idiopathic intracranial hypertension

“…Although this may be only natural as new promising techniques are developed, this discrepancy may imply that the pervasive opinion on VSS in the neurointerventional community is that it is a ‘simple’ and safe procedure. However, there is a known 1–2% major complication rate even in experienced hands,4 and in this survey, 11% of respondents reported a major complication during a VSS procedure, with two reported deaths. Having a life threatening complication from VSS was more commonly reported in higher volume operators, which may naturally be expected due to a higher denominator of cases, or could be secondary to other nuanced factors that this survey was unable to identify.…”

“…Meta-analyses of small series of VSS have demonstrated an excellent safety profile with improvement in headaches, pulsatile tinnitus, papilledema, and visual symptoms in the majority of patients 1–3. However, severe complications, including death, have been reported in 1–2% of patients treated with VSS 4. Importantly, very few published recommendations are available5 to guide interested physicians in selecting patients for treatment or for advice on the technical aspects of stenting.…”

Management of vascular causes of pulsatile tinnitus

“…In comparison to the aforementioned surgeries, venous sinus stenting (VSS) has a relatively favorable complication rate of 6.6%, with a major complication rate (which includes subdural hemorrhage, sinus or stent thrombosis, and retroperitoneal hemorrhage) of 2.3% 14 15. Relapse rates after VSS, however, can vary between 10–26% 16 17.…”

Transverse Sinus Stenting Reverses Medically Refractory Idiopathic Intracranial Hypertension

“…While headache immediately after stenting due to dural stretch was nearly universal, it was self-limiting within a few weeks. The complication rate here compared favourably with a 2021 multicentre database study (14), which identified 6 major complications from a total of 811 stents and 1,466 catheter venograms for IIH. These authors found 1 fatality after stenting, equating to a mortality of 0.1%.…”