Transverse sinus stenting without surgical repair in idiopathic CSF rhinorrhea associated with transverse sinus stenoses: a pilot study

Abstract

OBJECTIVE Based on their clinical and radiological patterns, idiopathic CSF rhinorrhea and idiopathic intracranial hypertension can represent different clinical expressions of the same underlying pathological process. Transverse sinus stenoses are associated with both diseases, resulting in eventual restriction of the venous CSF outflow pathway. While venous sinus stenting has emerged as a promising treatment for idiopathic intracranial hypertension, its efficiency on idiopathic CSF leaks has not been very well addressed in the literature so far. The purpose of this study was to report the results of transverse sinus stenting in patients with spontaneous CSF rhinorrhea associated with transverse sinus stenoses. METHODS From a prospectively collected database, the authors retrospectively collected the clinical and radiological features of the patients with spontaneous CSF leakage who were treated with venous sinus stenting. RESULTS Five female patients were included in this study. Transverse sinus stenoses were present in all patients, and other radiological signs of idiopathic intracranial hypertension were present in 4 patients. The median transstenotic pressure gradient was 6.5 mm Hg (range 3–9 mm Hg). Venous stenting resulted in the disappearance of the leak in 4 patients with no recurrence and no subsequent meningitis during the follow-up (median 12 months, range 6–63 months). CONCLUSIONS According to the authors’ results, venous sinus stenting may result in the disappearance of the leak in many cases of idiopathic CSF rhinorrhea. Larger comparative studies are needed to assess the efficiency and safety of venous stenting as a first-line approach in patients with spontaneous CSF rhinorrhea associated with transverse sinus stenoses.

Transverse Venous Stenting for the Treatment of Idiopathic Intracranial Hypertension With a Pressure Gradient of 70 mm Hg: A Technical Note and Systematic Review

“…Following an extensive systematic review, our patient's gradient pressure surpasses all others documented in the literature (Table). 3-52 According to our systematic review, the highest recorded gradient pressure was 67 mm Hg reported by Tschoe et al 36 who highlighted the impact of changes in mean arterial pressure and end-tidal carbon dioxide on venous sinus pressures in patients with IIH undergoing venous sinus stenting. Moreover, Ahmed et al reviewed clinical, venographic, and intracranial pressure data before and after stent placement in transverse sinus stenosis in 52 patients with IIH; the highest pressure gradient they reported was 41 mm Hg.…”

Dural sinus narrowing in patients with spontaneous anterior skull base cerebrospinal fluid leak

“…However, knowledge of the association between DVS narrowing and sCSF leak raises the possibility of finding a correctable underlying cause for sCSF leaks and foregoing these long‐term measures. In fact, DVS stenting as a stand‐alone treatment for sCSF leak with comorbid DVS narrowing has been reported 26,27 . More recently, Labeyrie et al published a retrospective case–control study evaluating the use of DVS stenting after repair of sCSF leak in patients with confirmed DVS narrowing.…”

“…In fact, DVS stenting as a stand‐alone treatment for sCSF leak with comorbid DVS narrowing has been reported. 26 , 27 More recently, Labeyrie et al published a retrospective case–control study evaluating the use of DVS stenting after repair of sCSF leak in patients with confirmed DVS narrowing. They found that DVS stenting resulted in significantly less recurrence of CSF leaks and trended toward less adjunctive treatment.…”

Expanding the clinical spectrum of idiopathic intracranial hypertension

“…Bilateral transverse venous sinus stenosis is a highly sensitive imaging marker of IIH found in almost all patients with IIH [ 6 ]; and venous sinus stenting (VSS) has emerged as an effective alternative treatment for a subset of patients with medically refractive IIH [ 62 ]. Some institutions have incorporated VSS into the management of patients with spontaneous CSF leak, either as a standalone procedure or as an adjunct to surgical repair as part of the treatment for elevated ICP [ 58 , 63 ]. There is insufficient evidence to support this practice in all patients with spontaneous CSF leak.…”