Stent Survival and Stent-Adjacent Stenosis Rates following Venous Sinus Stenting for Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis

Saber, Hamidreza; Lewis, Whitfield; Sadeghi, Mahsa; Rajah, Gary; Narayanan, Sandra

doi:10.1159/000490578

Cited by 57 publications

(67 citation statements)

References 28 publications

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“…In our study, the mean age was 29.1 years, and females accounted for 90.6% of all patients, which was similar to many previous studies that reported a high incidence in females, such as Zhoua et al [11], Saber et al [12], and Agarwal et al [13], in which females represented 90%, 86%, and 82% of the total study populations, respectively. IIH is common in overweight persons, and the mean body mass index of most studies was more than 25 kg/m 2 .…”

Section: Discussionsupporting

confidence: 90%

“…Tinnitus was found in 40.6% (13/32) of the patients in this study, while it was found in 56%, 52.4%, and 48.9% of the patients in Markey et al [19], Agarwal et al [13], and Saber et al [12], respectively. Diplopia was present in 15.6% (5/32) of patients at the time of presentation in this study, which is more or less similar to the 17% reported by Agarwal et al [13].…”

Section: Discussionmentioning

confidence: 43%

“…IIH is common in overweight persons, and the mean body mass index of most studies was more than 25 kg/m 2 . In the current study, the mean body mass index was 33.2 kg/m 2 , and it was 35.4 kg/m 2 , 35 kg/m 2 , 34.8 kg/m 2 , and 27.1 kg/m 2 in Patsalides et al [14], Chagot et al [15], Saber et al [12], and Agarwal et al [13], respectively.…”

Section: Discussionmentioning

confidence: 44%

“…Watane and Patel [7] and Friedman et al [18] reported diminution of vision in 45.57% and 34% of their patients, respectively. Agarwal et al [13] had a high proportion of patients with poor visual acuity (less than 6/18) and diminution of vision at presentation (36% and 62%, respectively), while the percent was 72.7% in Saber et al [12].…”

Section: Discussionmentioning

confidence: 94%

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“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

et al. 2019

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Objective: Assessment of visual field outcomes following the medical or surgical management of increased intracranial pressure in patients with idiopathic intracranial hypertension. Patient and methods: Thirty-two patients diagnosed with idiopathic intracranial hypertension who met all the modified Dandy criteria were included in this study. Magnetic resonance brain imaging with contrast and magnetic resonance venography were performed to exclude the presence of secondary causes of intracranial hypertension. Following normal neuroimaging, a lumbar puncture was performed for all patients with papilledema to measure the cerebrospinal fluid opening pressure. The assessment of visual function, including visual acuity, fundus examination (dilated fundus examination to confirm the presence and the grade of papilledema and to exclude the other ocular causes of optic disc swelling), and formal visual field assessment by perimetry when visual acuity was more than 1/60 were performed by the ophthalmologist before and after medical or surgical treatment. Results: Thirty-two patients were included, the majority of whom were females of childbearing age (29/32; 90.6%). All patients complained of headache. Visual assessment revealed the presence of blurry vision in all patients. Papilledema with different grades was observed in 31/32 (96.9%) patients, while the other patient (3.1%) showed optic atrophy; 30/ 32 (93.8%) patients had visual acuity ˃ 1/60. The average visual field was − 18 dB ± 9.97 SD in the right eye and − 19.47 dB ± 5.43 SD in the left eye. Twenty-nine patients received medical treatment in the form of acetazolamide, which succeeded in controlling idiopathic intracranial hypertension in 24/29 (82.7%) patients, while a theco-peritoneal shunt was inserted in 8/32 (25%) patients. After management, statistically significant improvements in cerebrospinal fluid opening pressure, presenting manifestation, visual acuity, and field were noticed. Conclusions: Permanent visual loss is the most feared complication of idiopathic intracranial hypertension; therefore, early diagnosis and multidisciplinary treatment are necessary to improve visual acuity and visual field.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 44%

Section: Discussionmentioning

confidence: 94%

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“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

et al. 2019

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“…Starke's review found 10 (5.4%) complications reported among 185 patients from a database covering 2002–2014, including a similar symptom improvement rate (Starke et al, 2015). In a more recent updated review, it is concluded from 29 articles comprising 410 patients that venous sinus stenting is associated with high technical success (99.5%), low rates of repeated procedure (10%) and low major complication rates (1.5%) (Saber, Lewis, Sadeghi, Rajah, & Narayanan, ). In our study, significant subjective ophthalmological improvement or recovery was reported in 84.5% of patients, which is consistent with these previous studies.…”

Section: Discussionmentioning

confidence: 99%

Endovascular stenting for idiopathic intracranial hypertension with venous sinus stenosis

Liu

Wang

et al. 2019

Brain and Behavior

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Objectives Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure of unknown etiology and venous sinus stenting may be an optional treatment. We aimed to evaluate the effects of venous sinus stenting on visual function, intracranial pressure, and trans‐stenotic pressure gradient of the patients with IIH and to determine effects of baseline BMI or weight changes on subjective vision outcome and intracranial pressure. Methods From July 2009 to Aug 2016, 88 eligible patients with IIH and venous sinus stenosis who underwent stenting were retrospectively studied. Results In this study, 67 women and 21 men were included with an average age of 39.01 (18–60) years. The average BMI was 26.75 kg/m 2 . Here, 66 (75.9%) patients had papilledema, 39 had impaired vision before stenting; 57 patients were followed‐up, 48 (84.2%) showed significant subjective improvement or recovery in visual acuity, 4 (7.0%) patients reported no significant change in visual functions, and 5 (8.8%) suffered permanent vision loss. The cerebrospinal fluid opening pressure and trans‐stenotic pressure gradient were significantly decreased postoperatively. Baseline BMI was associated with pre‐and postoperative trans‐stenotic pressure gradients, as well as changes in cerebrospinal fluid opening pressure. However, baseline BMI and body weight changes during follow‐up were not necessarily associated with subjective visual outcomes after stenting. Stenting efficacy was limited in patients with severe preoperative optic symptoms. Conclusions Venous sinus stenting represented an effective treatment for resolving visual dysfunction and intracranial pressure associated with venous sinus stenosis. BMI seemed to be associated with intracranial pressure but not subjective visual outcomes after stenting.

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Assessment of Safety of a Fully Implanted Endovascular Brain-Computer Interface for Severe Paralysis in 4 Patients

Mitchell

Lee

Yoo³

et al. 2023

JAMA Neurol

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ImportanceBrain-computer interface (BCI) implants have previously required craniotomy to deliver penetrating or surface electrodes to the brain. Whether a minimally invasive endovascular technique to deliver recording electrodes through the jugular vein to superior sagittal sinus is safe and feasible is unknown.ObjectiveTo assess the safety of an endovascular BCI and feasibility of using the system to control a computer by thought.Design, Setting, and ParticipantsThe Stentrode With Thought-Controlled Digital Switch (SWITCH) study, a single-center, prospective, first in-human study, evaluated 5 patients with severe bilateral upper-limb paralysis, with a follow-up of 12 months. From a referred sample, 4 patients with amyotrophic lateral sclerosis and 1 with primary lateral sclerosis met inclusion criteria and were enrolled in the study. Surgical procedures and follow-up visits were performed at the Royal Melbourne Hospital, Parkville, Australia. Training sessions were performed at patients’ homes and at a university clinic. The study start date was May 27, 2019, and final follow-up was completed January 9, 2022.InterventionsRecording devices were delivered via catheter and connected to subcutaneous electronic units. Devices communicated wirelessly to an external device for personal computer control.Main Outcomes and MeasuresThe primary safety end point was device-related serious adverse events resulting in death or permanent increased disability. Secondary end points were blood vessel occlusion and device migration. Exploratory end points were signal fidelity and stability over 12 months, number of distinct commands created by neuronal activity, and use of system for digital device control.ResultsOf 4 patients included in analyses, all were male, and the mean (SD) age was 61 (17) years. Patients with preserved motor cortex activity and suitable venous anatomy were implanted. Each completed 12-month follow-up with no serious adverse events and no vessel occlusion or device migration. Mean (SD) signal bandwidth was 233 (16) Hz and was stable throughout study in all 4 patients (SD range across all sessions, 7-32 Hz). At least 5 attempted movement types were decoded offline, and each patient successfully controlled a computer with the BCI.Conclusions and RelevanceEndovascular access to the sensorimotor cortex is an alternative to placing BCI electrodes in or on the dura by open-brain surgery. These final safety and feasibility data from the first in-human SWITCH study indicate that it is possible to record neural signals from a blood vessel. The favorable safety profile could promote wider and more rapid translation of BCI to people with paralysis.Trial RegistrationClinicalTrials.gov Identifier: NCT03834857

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Stent Survival and Stent-Adjacent Stenosis Rates following Venous Sinus Stenting for Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis

Cited by 57 publications

References 28 publications

“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

Endovascular stenting for idiopathic intracranial hypertension with venous sinus stenosis

Assessment of Safety of a Fully Implanted Endovascular Brain-Computer Interface for Severe Paralysis in 4 Patients

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