Venous sinus stenting in patients without idiopathic intracranial hypertension

Authors

Michael R. Levitt, Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Felipe C. Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Bradley A. Gross, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Karam Moon, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Ashutosh P. Jadhav, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.Follow
Andrew F. Ducruet, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.Follow
R Webster Crowley, Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.

Document Type

Article

Abstract

BACKGROUND: Venous sinus stenting is an effective treatment for patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis. OBJECTIVE: To determine the usefulness of venous sinus stenting in the treatment of patients with symptomatic venous sinus stenosis without a diagnosis of IIH. METHODS: We performed a retrospective review of a prospective multicenter database of patients undergoing venous sinus stenting between January 2008 and February 2016. Patients with acute dural venous sinus thrombosis, arteriovenous fistula or arteriovenous malformation, or IIH were excluded. Clinical, radiological, and ophthalmological information was recorded. RESULTS: Nine patients met the inclusion criteria and underwent venous sinus stenting for symptomatic dural venous sinus stenosis. Reasons for treatment included isolated unilateral pulsatile tinnitus (n=1), congenital hydrocephalus (n=2), unilateral pulsatile tinnitus following prior venous sinus thrombosis (n=1), acquired hydrocephalus following dural sinus thrombosis (n=2), meningitis (n=2) and tumor invasion into the dural venous sinus (n=1). Six patients underwent lumbar puncture or shunt tap, and all of these patients had elevated intracranial pressure. All stenoses were located in the transverse sinus, transverse-sigmoid junction and/or jugular bulb, and all were treated with self-expanding bare-metal stents. At follow-up, clinical symptoms had resolved in all but two patients, both of whom had congenital hydrocephalus and pre-existing shunts. There was no significant in-stent stenosis, and patients with ophthalmological follow-up demonstrated improvement of papilledema. CONCLUSIONS: Dural venous sinus stenting may be an effective treatment for patients with symptomatic venous sinus stenosis without IIH in carefully selected cases, but may not be effective in resolving the symptoms of congenital hydrocephalus.

Keywords

Hydrocephalus, Intracranial Pressure, Stenosis, Stent, Vein

Medical Subject Headings

Adolescent; Adult; Aged; Cranial Sinuses (diagnostic imaging, surgery); Female; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Pseudotumor Cerebri; Retrospective Studies; Sinus Thrombosis, Intracranial (diagnostic imaging, surgery); Stents (adverse effects); Treatment Outcome; Young Adult

Publication Date

5-1-2017

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

Volume

9

Issue

5

First Page

512

Last Page

515

PubMed ID

27199383

Digital Object Identifier (DOI)

10.1136/neurintsurg-2016-012405

Recommended Citation

Levitt, Michael R.; Albuquerque, Felipe C.; Gross, Bradley A.; Moon, Karam; Jadhav, Ashutosh P.; Ducruet, Andrew F.; and Crowley, R Webster, "Venous sinus stenting in patients without idiopathic intracranial hypertension" (2017). Translational Neuroscience. 2187.
https://scholar.barrowneuro.org/neurobiology/2187