Venous sinus stenting after repair of skull base spontaneous cerebrospinal fluid leaks: A single-center retrospective cohort series with case-control analysis

Labeyrie, Marc‐Antoine; Bedarida, Vincent; Vever, Ursulla; Guédon, Alexis; Herman, Philippe; Vérillaud, Benjamin; Houdart, Emmanuel

doi:10.1016/j.neurad.2021.07.002

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…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 28 . Notably, their study does not describe the long‐term efficacy of stenting for lowering intracranial pressure in the absence of other interventions.…”

Section: Discussionmentioning

confidence: 97%

“…They found that DVS stenting resulted in significantly less recurrence of CSF leaks and trended toward less adjunctive treatment. 28…”

Section: Discussionmentioning

confidence: 99%

“…They found that DVS stenting resulted in significantly less recurrence of CSF leaks and trended toward less adjunctive treatment. 28 Notably, their study does not describe the long‐term efficacy of stenting for lowering intracranial pressure in the absence of other interventions. Further, the risks of stenting, including intracranial hemorrhage, stroke, and risks of postprocedural dual antiplatelet therapy must be considered.…”

Section: Discussionmentioning

confidence: 99%

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

Asi

Cameron

Friedman

et al. 2023

Laryngoscope Investig Oto

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Objectives Current evidence suggests a link between idiopathic intracranial hypertension (IIH) and spontaneous cerebrospinal fluid (sCSF) leak, as well as between IIH and dural venous sinus (DVS) narrowing. However, there are limited data linking DVS narrowing and sCSF leak. This study aims to determine the prevalence of DVS narrowing in patients with sCSF leak. Methods A retrospective review of all patients with sCSF leak that presented to a tertiary academic center from 2008 to 2019. Preoperative imaging was independently reviewed by two neuroradiologists to evaluate for DVS narrowing. Available literature was used to estimate the prevalence of DVS narrowing in the general population to allow for comparison. Data were analyzed using Exact binomial test. Results Analysis of 25 patients with appropriate imaging revealed the majority were women (21/25, 84%) with a mean age of 51.89 years (SD 13.96). The majority of these patients were found to have narrowing of the DVS (20/25, 80%). In patient with sCSF leaks, there was a significantly higher proportion of patients with DVS narrowing compared with published literature examining this condition in the general population (80% vs. 40%, CI 0.59–0.93, p < .001). Conclusion The prevalence of DVS narrowing in patients with sCSF leaks is substantial and likely greater than the general population. Moreover, there appears to be narrowing in most patients with sCSF leak. Preoperative radiological evaluation of the DVS using MR venography may be useful in patients with sCSF leaks as DVS stenosis may be an underdiagnosed etiology. Further study is needed to evaluate this. Level of Evidence IV.

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Section: Discussionmentioning

confidence: 97%

“…They found that DVS stenting resulted in significantly less recurrence of CSF leaks and trended toward less adjunctive treatment. 28…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Asi

Cameron

Friedman

et al. 2023

Laryngoscope Investig Oto

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“…Thus, it appeared that in the presence of a CSF leak, VSS strongly suggests that the underlying etiology is IIH and that repairing the leak may lead either to an IIH exacerbation or a new compensatory leak. Labeyrie et al 65 compared 10 patients treated with prophylactic stenting after CSF repair with 18 patients who were followed conservatively and found that those who underwent stenting had a reduced chance of leak recurrence (0% vs 38%) or need for secondary leak repair, providing preliminary evidence that patients with VSS should be considered for stenting after CSF leak repair, even if they are asymptomatic. Larger prospective studies of stenting in leak patients are necessary to confirm these findings.…”

Section: Encephaloceles and Venous Sinus Stenosismentioning

confidence: 99%

Idiopathic Intracranial Venous Hypertension: Toward a Better Understanding of Venous Stenosis and the Role of Stenting in Idiopathic Intracranial Hypertension

Dinkin¹,

Patsalides²

2023

Journal of Neuro-Ophthalmology

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Background: Venous sinus stenosis, typically at the junction of the transverse and sigmoid sinus, is increasingly recognized as a contributor to the pathophysiology of idiopathic intracranial hypertension (IIH), whether it be the intrinsic type that does not reverse with normalization of intracranial pressure or the extrinsic type, which does. Efforts to treat the stenosis and reduce the associated transstenotic gradient through placement of a stent at the site of stenosis have been studied over the past 2 decades, primarily through retrospective studies, with variable emphasis on formal visual testing and direct assessment of poststent opening pressure. Most studies have presented evidence for utilization of stenting as an alternative to cerebrospinal fluid shunting or optic nerve sheath fenestration in patients with IIH who harbor the stenosis and are refractory to or intolerant of intracranial pressure–lowering medications, but an assessment of the current data is needed to better understand the role of stenting for this patient population. Evidence Acquisition: A search in PubMed was made for “IIH,” “papilledema,” and “venous stenting.” Data pre and post stenting, including symptoms attributable to IIH, intracranial pressure, papilledema, retinal nerve fiber layer thickening on optical coherence tomography, and visual field assessment (mean deviation), were collected. Need for retreatment and complications were assessed among all studies. Studies using stenting for special circumstances, such as cerebrospinal leaks or for stenosis along anomalous vessels, were reviewed. Results: In total, 49 studies (45 retrospective and 4 prospective) and 18 case reports (with 3 or less patients) were found and included in the analysis, for a total of 1,626 patients. In 250 patients in whom poststent intracranial pressure was measured, the mean value was 19.7 cm H2O, reduced from a mean of 33 cm H2O. Transient visual obscurations resolved in 79.6% of 201 patients who complained of it, pulsatile tinnitus resolved in 84.7% of 515, diplopia resolved in 93% of 86 patients, and nonspecific visual symptoms such as “blurry vision” improved in 76.2% of 537 patients. Headaches resolved in 36% and improved in a further 40.7% of 1,105 patients in whom they were documented before stenting. Of 1,116 with papilledema, 40.8% demonstrated resolution and 38.2% improvement. The mean retinal nerve fiber layer thickness improved from 170.2 µm to 89.2 µm among 402 eyes in which optical coherence tomography was used to measure it. Among 135 eyes in which formal visual fields were performed pre and post stenting, the prestent average mean deviation of −7.35 dB improved to −4.72 dB after stenting. Complications associated with stenting included in-stent stenosis or thrombosis, subdural hematoma, intracerebral hematoma, cerebral edema, stent migration, and death. A recurrence of symptoms requiring a follow-up surgical intervention occurred in 9%. Conclusions: A growing body of evidence supports the use of venous sinus stenting as a viable option for medically refractory IIH, especially when papilledema threatens visual function. Complication and failure rates seem to be similar to alternative surgical approaches, although serious neurological sequalae can rarely occur. Emerging studies evaluating stent type, including novel stents designed for use in the venous system, may help improve ease of the procedure and long-term success rates. Prospective head-to-head studies are needed to better understand the performance of stenting compared with other interventions.

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Letter to the editor of Acta Neurochirurgica: Combined surgical repair and venous sinus stenting for patients with skull base encephaloceles secondary to dural venous sinus stenosis

Gallia,

Moghekar,

Owler

et al. 2024

Acta Neurochir

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Venous sinus stenting after repair of skull base spontaneous cerebrospinal fluid leaks: A single-center retrospective cohort series with case-control analysis

Cited by 4 publications

References 26 publications

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

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

Idiopathic Intracranial Venous Hypertension: Toward a Better Understanding of Venous Stenosis and the Role of Stenting in Idiopathic Intracranial Hypertension

Letter to the editor of Acta Neurochirurgica: Combined surgical repair and venous sinus stenting for patients with skull base encephaloceles secondary to dural venous sinus stenosis

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