Venous sinus stenting for idiopathic intracranial hypertension: a review of the literature

Abstract

Idiopathic intracranial hypertension (IIH) is characterized by headache, papilledema, visual field changes and tinnitus with elevated cerebral spinal fluid opening pressures on lumbar puncture. Left untreated, this condition can lead to permanent visual loss. Previous treatment modalities include medical management, therapeutic lumbar puncture and optic nerve sheath fenestration. They have proved to be effective but carry high rates of symptom recurrence or procedural complications. Focal dural venous sinus stenoses have been identified in many patients with IIH, leading to development of treatment through venous sinus angioplasty and stenting. A review of the literature was performed which identified patients with IIH treated with venous sinus stenting. The procedural data and outcomes are presented. A total of 143 patients with IIH (87% women, mean age 41.4 years, mean body mass index 31.6 kg/m(2)) treated with venous sinus stenting were included in the analysis. Symptoms at initial presentation included headache (90%), papilledema (89%), visual changes (62%) and pulsatile tinnitus (48%). There was a technical success rate of 99% for the stent placement procedure with a total of nine complications (6%). At follow-up (mean 22.3 months), 88% of patients experienced improvement in headache, 97% demonstrated improvement or resolution of papilledema, 87% experienced improvement or resolution of visual symptoms and 93% had resolution of pulsatile tinnitus. In patients with IIH with focal venous sinus stenosis, endovascular stent placement across the stenotic sinus region represents an effective treatment strategy with a high technical success rate and decreased rate of complications compared with treatment modalities currently used.

Meta-Analysis of CSF Diversion Procedures and Dural Venous Sinus Stenting in the Setting of Medically Refractory Idiopathic Intracranial Hypertension

“…A second is decreased CSF absorption by the arachnoid granulations, which are pressure-sensitive. 3,12,16,17,20 Stent placement has been hypothesized to lower intracranial pressure by removing a Starling-like resistor, thereby removing the positive feedback loop. 19 With noninvasive imaging, such as contrast-enhanced MRV, 3 patterns of dural venous sinus stenting may be amenable to sinus stent placement:…”

“…1 The overall prevalence of IIH in North America has been estimated to be 0.9 -1.07/100,000 2,3 ; however, in women with obesity between 20 and 44 years of age, the prevalence rises to 15-19/100,000. 2 Although headache is the most common presenting symptom, seen in 92%-94% of patients, 4,5 IIH also represents a significant cause of chronic headaches.…”

A comparison of lumboperitoneal and ventriculoperitoneal shunting for idiopathic intracranial hypertension: an analysis of economic impact and complications using the Nationwide Inpatient Sample

“…20 Complication rates were noted to be 6%, including a 2% incidence of subdural hematoma. 20 This new treatment modality looks to be a valuable tool in the specific subset of patients with IIH and focal venous stenosis.…”

“…15 Patients are considered candidates for stent placement with focal stenosis typically presenting in the transverse or sigmoid sinus. 20 This procedure is technically feasible and highly effective, with a review noting improvement in headaches of as much as 88% and resolution of papilledema in 97% of patients. 20 Complication rates were noted to be 6%, including a 2% incidence of subdural hematoma.…”

“…20 This procedure is technically feasible and highly effective, with a review noting improvement in headaches of as much as 88% and resolution of papilledema in 97% of patients. 20 Complication rates were noted to be 6%, including a 2% incidence of subdural hematoma. 20 This new treatment modality looks to be a valuable tool in the specific subset of patients with IIH and focal venous stenosis.…”