Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis

Nicholson, Patrick; Brinjikji, Waleed; Radovanović, Ivan; Hilditch, Christopher Alan; Tsang, Anderson Chun On; Krings, Timo; Pereira, Vítor Mendes; Lenck, Stéphanie

doi:10.1136/neurintsurg-2018-014172

Cited by 154 publications

(167 citation statements)

References 27 publications

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“…There is an expanding body of literature on stenting of intracranial venous sinuses for a range of indications (24)(25)(26)(27)(28)(29)(30)(31)(42)(43)(44)(45)(46)(47). This literature exposes the possible risks of intracranial stenting, particularly in-stent thrombosis, and provides strategies for prevention of these complications, namely anticoagulation and antiplatelet therapy.…”

Section: Stent Safety: Lessons From Venous Sinus Stentingmentioning

confidence: 99%

“…Greater experience exists with stenting of the transverse sinuses for the treatment of idiopathic intracranial hypertension (24)(25)(26)(27)(28)(29)(30)(31). According to recent systematic reviews, the overall complication rate associated with this intervention, including minor complications such as wound hematomas or pseudoaneurysms, is 1-7% (24)(25)(26)(27)(28)(29). Major neurological complications, such as in-stent thrombosis and subdural,…”

Section: Stent Safety: Lessons From Venous Sinus Stentingmentioning

confidence: 99%

“…Frontiers in Neurology | www.frontiersin.org extradural, subarachnoid, or intracerebral hemorrhage, due to venous injury, occur at a rate of 1-3% (24)(25)(26)(27)(28)(29). Delayed re-stenosis within, or adjacent to, the stent construct is another undesirable outcome after this therapy.…”

Section: Aptt Activated Partial Thromboplastin Time; Cvst Cerebral mentioning

confidence: 99%

“…According to one systematic review the rate of in-stent stenosis was 3.4% after a mean radiographic follow-up period of 15.2 months (28). Stentadjacent stenosis is comparatively more common, occurring in approximately 10-15% of patients (28,29). However, these complications may be secondary to high intracranial pressure gradients encountered in patients with IIH and may be less likely if stents were to be implanted in individuals with normal intracranial pressure.…”

Section: Aptt Activated Partial Thromboplastin Time; Cvst Cerebral mentioning

confidence: 99%

“…Given the current absence of human trial data on the Stentrode TM , existing literature on structurally comparable devices may provide valuable insights into these risks and their possible preventative strategies. For example, there is a growing number of studies on stent deployment in the intracranial sinuses for a range of indications (24)(25)(26)(27)(28)(29)(30)(31), from which possible stent-related complications of the Stentrode TM may be surmised. Although a transvenous lead has never been previously implanted in the human brain, substantial lessons about the safety and design characteristics of transvenous leads can be taken from the literature on cardiac electrotherapy devices (32)(33)(34)(35)(36).…”

Section: Introductionmentioning

confidence: 99%

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Endovascular Neuromodulation: Safety Profile and Future Directions

et al. 2020

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Endovascular neuromodulation is an emerging technology that represents a synthesis between interventional neurology and neural engineering. The prototypical endovascular neural interface is the Stentrode TM , a stent-electrode array which can be implanted into the superior sagittal sinus via percutaneous catheter venography, and transmits signals through a transvenous lead to a receiver located subcutaneously in the chest. Whilst the Stentrode TM has been conceptually validated in ovine models, questions remain about the long term viability and safety of this device in human recipients. Although technical precedence for venous sinus stenting already exists in the setting of idiopathic intracranial hypertension, long term implantation of a lead within the intracranial veins has never been previously achieved. Contrastingly, transvenous leads have been successfully employed for decades in the setting of implantable cardiac pacemakers and defibrillators. In the current absence of human data on the Stentrode TM , the literature on these structurally comparable devices provides valuable lessons that can be translated to the setting of endovascular neuromodulation. This review will explore this literature in order to understand the potential risks of the Stentrode TM and define avenues where further research and development are necessary in order to optimize this device for human application.

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Section: Stent Safety: Lessons From Venous Sinus Stentingmentioning

confidence: 99%

Section: Stent Safety: Lessons From Venous Sinus Stentingmentioning

confidence: 99%

Section: Aptt Activated Partial Thromboplastin Time; Cvst Cerebral mentioning

confidence: 99%

Section: Aptt Activated Partial Thromboplastin Time; Cvst Cerebral mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endovascular Neuromodulation: Safety Profile and Future Directions

et al. 2020

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Association of spontaneous cerebrospinal fluid rhinorrhea with transverse venous sinus stenosis: a retrospective matched case‐control study

Bedarida

Labeyrie

Eliezer

et al. 2020

Int Forum Allergy Rhinol

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Background A significant proportion of spontaneous cerebrospinal fluid sCSF leaks are associated with idiopathic intracranial hypertension IIH The aim of this study was to assess the association between sCSF rhinorrhea and transverse venous sinus stenosis VSS a feature commonly observed in IIH with a proposed role in its pathophysiology Methods In this single-center retrospective matched case-control study venous and pituitary imaging data of consecutive patients undergoing endoscopic surgery for sCSF rhinorrhea over the last years were retrospectively reviewed Measurement of the height of the pituitary gland was used to assess empty sella and VSS was quantified as the ratio between the minimal area of the transverse sinus and the cross-sectional area of the sigmoid sinus VSS was considered significant when it was ≥ and bilateral Cases were compared with age-and sex-adjusted controls explored for causes other than IIH intracranial mass effect or venous thrombosis Results Twenty-nine patients were included median age years females body mass index BMI kg/m Cases had a significantly lower height of the pituitary gland than controls mm vs mm p < Bilateral VSS was found in of cases confidence interval CI to vs of controls CI to with p < Conclusion In this retrospective study sCSF leaks were strongly associated with VSS This novel finding provides a rationale for further investigation of the role of VSS in the onset of sCSF leaks and of the potential interest in venous stenting a er the surgical repair of leaks © 2020 ARS-AAOA, LLC.

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Advances in the Understanding of the Complex Role of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension

Zhao

Liu

et al. 2022

Magnetic Resonance Imaging

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Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated intracranial pressure (ICP) that predominantly affects young obese women. IIH is a diagnosis of exclusion. That is, if increased ICP is suspected, magnetic resonance imaging and magnetic resonance venography of the brain are recommended to exclude secondary causes. Imaging findings, such as empty sella, orbital findings, meningocele, and encephalocele, are not diagnostic of ICP, nor does their absence exclude ICP either. Therefore, venous manometry is recommended as the gold standard for evaluation, regardless of previous anatomic imaging results. Venous manometry is an invasive examination that is frequently applied to derive physiologic information concerning the nature of the pressure gradient. However, the pathogenesis of IIH has not been fully elucidated. The presence of venous sinus stenosis in a subset of patients has provided some support for the potential mechanisms underlying this condition. Hence, this review provides an up‐to‐date discussion on the potential pathogenic mechanisms of IIH with a special focus on venous sinus stenosis.Level of Evidence1Technical Efficacy Stage2

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Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis

Abstract: Venous sinus stenting in patients with IIH who are refractory to medical therapy appears to have an excellent safety profile and is associated with significant improvements in headaches, pulsatile tinnitus, and papilledema.

Cited by 154 publications

References 27 publications

Endovascular Neuromodulation: Safety Profile and Future Directions

Endovascular Neuromodulation: Safety Profile and Future Directions

Association of spontaneous cerebrospinal fluid rhinorrhea with transverse venous sinus stenosis: a retrospective matched case‐control study

Advances in the Understanding of the Complex Role of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension

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