Neuroendovascular Cerebral Sinus Stenting in Idiopathic Intracranial Hypertension

Abstract

Idiopathic intracranial hypertension (IIH) is a rare, ill-understood disease of significant morbidity. Because the pathophysiology is poorly understood, treatment protocols are not uniform and are directed towards alleviating the most common symptoms: headache and visual loss. In this review, we analyze 25 case series, all of which included IIH patients (n = 408) who were treated with placement of a venous sinus stent. Among 342 patients who had headache, 240 patients (70.2%) had improvement or resolution of headache after the stent insertion. Of the 217 patients documented to have visual problems, visual acuity was improved or stabilized in 161 patients (74.2%). Of the 304 patients with papilledema, 257 showed resolution or improved (84.5%). Of the 124 patients who presented with pulsatile tinnitus, it was resolved in 110 patients (88.7%) after stent placement. Endovascular management of dural sinus stenosis is therefore clinically efficacious in patients with IIH who have failed medical and surgical therapy.

Casper Versus Precise Stent for the Treatment of Patients with Idiopathic Intracranial Hypertension

“…Our data also underline the safety and efficacy of VSS in IIH patients with venous sinus stenosis [4][5][6][7][8][9]. Other than VSS, few treatment options are available for patients who do not respond adequately to conservative treatment [18].…”

“…The increased intracranial pressure observed in patients with IIH may lead to permanent damage of the optic nerve and fulminant vision loss [2]. Venous sinus stenting (VSS) has emerged as a promising and efficient treatment alternative for IIH patients whose condition is not improved by conservative treatment and who demonstrate a functionally relevant venous sinus stenosis [3][4][5][6][7][8][9]; however, device delivery may be challenging owing to the tortuosity of the transverse and sigmoid sinuses, the high degree of stenosis, the angle of the stenotic segment, small venous channels within the sinus, arachnoid granulations, fibrous trabeculae or the presence of a cortical vein draining into the dural venous sinuses, which are frequently observed in IIH patients [10][11][12][13]. Forced device maneuvers can lead to severe hemorrhagic complications including avulsion of cortical veins and dissection or perforation of the sinus [14][15][16].…”

Trends in the Surgical Treatment of Pseudotumor Cerebri Syndrome in the United States

“…It is also possible that shunting is gradually being replaced by venous sinus stenting; we were unable to confirm this because of the lack of validated procedure codes for venous sinus stenting in PTCS. However, although stenting has increased in recent years, the literature remains limited to case series from a handful of centers 20 ; therefore, we do not believe that this is sufficient to explain the magnitude of decline in shunting that we observed in the NIS data. Of note, the plateau in the rate of shunting for PTCS after 2011 also coincides with the redesign of the NIS sampling frame in 2012.…”

A Unique Subset: Idiopathic Intracranial Hypertension Presenting as Spontaneous CSF Leak of the Anterior Skull Base

“…However, venous imaging was only performed in 6 of the 26 studies analyzed in this review, including our own patient series, and as such, it remains unclear whether its prevalence in spontaneous CSF leaks is due to true pathophysiology versus underreporting. Venous sinus stenosis has been well-described in the general IIH literature, and a recent literature review of endovascular venous sinus stenting for IIH 34 reported improvement or resolution of IIH symptoms, including headaches, visual acuity, papilledema, and tinnitus in over 70% of patients. As such, venous sinus stenting has been advocated for in classic IIH patients with persistent symptoms, refractory to medical management and with elevated opening pressures and pressure gradients across the stenosis.…”