Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting

Abstract

VSS for patients with IIH with venous sinus stenosis is now an established and effective treatment option. These recommendations have been provided, based on a summative review of the available published literature, to assist in standardizing care for patients with IIH undergoing VSS.

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

“…21 The appropriate cut-off has not been established to determine which patients are appropriate candidates for stenting, although most interventionalists have used a minimum TSG of 4 to 10 mm Hg. 6,[22][23][24][25][26] Some groups measure the TSG before and after lumbar puncture and do not proceed with stenting if the TSG resolves (suggesting an extrinsic stenosis), believing that only intrinsic stenosis plays a causative role in the disease. However, the positive feedback loop theory discussed earlier and evidence demonstrating efficacy of stenting in patients with both intrinsic and extrinsic stenosis (see later) support consideration of the procedure in both cases.…”

“…This is typically followed by low-dose aspirin alone, anywhere from 6 months to lifetime. 26 Although venous sinus stenting access is typically made through a transfemoral approach, Buell and colleagues described an alternative transcranial approach in which a Burr hole was placed over the side of the right TS. Two balloonmounted stents were placed into the sinus to bypass a tortuous jugular bulb that would not allow passage of the rigid stent.…”

Stauungspapille, Pseudotumor cerebri und idiopathische intrakranielle Hypertension – Was gibt es Neues?

“…Die endovaskuläre Therapie venöser Sinusvenenstenosen ist für geeignete Fälle ebenfalls eine gute Therapieoption [39]. Jedoch fehlen hierzu noch prospektive Daten aus hochwertigen Studien, Langzeitbeobachtungen und einheitliche Standards [40]. Eine interdisziplinäre Zusammenarbeit zwischen Ophthalmologen, Neurologen und Neurochirurgen ist unerlässlich.…”

An Evolving Therapy – Dural Venous Sinus Stenting for Idiopathic Intracranial Hypertension

“…1 IIH occurs with an incidence of 1-2 per 100,000 individuals in North America, and 14.9-19.3 per 100,000 among obese women aged 20-44. 2 Diagnostic criteria include symptoms of increased intracranial pressure, normal neurological exam excluding possible visual deficits, negative brain imaging via CT/MRI, and opening pressure >25 cm H 2 0 on lumbar puncture (LP). 1 While pathophysiology remains controversial, recent studies have established the presence of unilateral or bilateral transverse sinus stenosis in most IIH patients, representing the most reliable imaging indicator of the disease state.…”

“…1 Cerebrospinal fluid diversion via shunt placement and optic nerve sheath fenestration are also used in refractory patients but carry significant complication and recurrence rates. 2 A retrospective meta-analysis of 410 IIH patients undergoing DVSS reported significant post-procedure improvement in headache (82%), papilledema (92%), and visual acuity (78%). 7 The overall complication rate was 4.9%, and major complications comprising intracranial hemorrhage, subarachnoid hemorrhage, and subdural hematoma were seen in 1.5% of patients.…”