Endovascular Treatment for Venous Sinus Stenosis in Idiopathic Intracranial Hypertension: An Observational Study of Clinical Indications, Surgical Technique, and Long-Term Outcomes

• Published in: World neurosurgery Vol. 121; pp. e165 - e171
• Main Authors: Shields, Lisa B.E., Shields, Christopher B., Yao, Tom L., Plato, Brian M., Zhang, Yi Ping, Dashti, Shervin R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2019
• Subjects: Endovascular; Idiopathic intracranial hypertension; Neurosurgery; Pseudotumor cerebri; Stent; Venous sinus stenosis; Pseudotumor cerebri; Venous sinus stenosis; MRV; MRI; Endovascular; Idiopathic intracranial hypertension; CSF; IIH; Neurosurgery; Stent
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.09.070

Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure. IIH causes significant morbidity marked by incapacitating headaches and visual disturbances. This study investigated the long-term outcomes of venous sinus stenting in a large group of patients with IIH. We retrospectively reviewed all patients at our institution who underwent venous sinus stenting for IIH over 6 years (July 1, 2012–June 30, 2018). A particular focus was dedicated to collecting demographic, clinical, radiologic, and outcomes data. All patients had failed medical management. Of the 110 patients evaluated for IIH, 42 underwent venous sinus stenting, with a mean follow-up of 25.6 months (range, 8.7–60.7 months). The mean age was 32 years (range, 15–52 years), 38 (90%) were women, and the mean body mass index was 35.6 kg/m2 (range, 18.6–47.5 kg/m2). Prior to the stenting procedure, all patients had headaches, visual disturbances, and papilledema. Of the 39 patients who had an ophthalmologic evaluation poststenting, 29 (74%) had resolution of their papilledema. Eighteen patients (43%) had complete resolution of their headaches after the stenting procedure, whereas 22 patients (52%) remained under a neurologist's care for chronic migraine and other types of headaches. Two patients underwent a restenting procedure for disease progression, and 1 patient experienced an in-stent thrombosis. A multidisciplinary approach involving neurosurgeons, ophthalmologists, radiologists, and neurologists is integral in the management of patients with IIH to prevent the complications of papilledema. Venous sinus stenting offers a safe and effective means of treating IIH. •IIH affects obese women of childbearing age.•IIH is marked by headaches, papilledema, visual loss, and pulsatile tinnitus.•Papilledema is the most concerning neurologic sign.•There is an overlap between patients with IIH and chronic migraine headaches.•Venous sinus stenting offers a safe means of treating papilledema linked to IIH.