Title

Venous sinus stenting shortens the duration of medical therapy for increased intracranial pressure secondary to venous sinus stenosis

Document Type

Article

Abstract

INTRODUCTION: Medical treatment, cerebrospinal fluid (CSF) shunting, and optic nerve sheath fenestration are standard treatments for increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). Venous sinus stenting provides a novel alternative surgical treatment in cases of venous sinus stenosis with elevated ICP. METHODS: 12 consecutive subjects with papilledema, increased ICP, and radiological signs of dural sinus stenosis underwent cerebral venography and manometry. All subjects had papilledema and demonstrated radiological evidence of dural venous sinus stenosis. RESULTS: Six subjects chose venous stenting (Group A) and six declined and were managed conservatively with oral acetazolamide (Group B). The relative pressure gradient across the venous narrowing was 29±16.3 mm Hg in Group A and 17.6±9.3 mm Hg in Group B (p=0.09). The mean lumbar puncture opening pressure was 40.4±7.6 cm HO in Group A and 35.6±10.6 cm HO in Group B (p=0.4). Spectral domain optical coherence tomography (SD-OCT) showed mean average retinal nerve fiber layer (RNFL) thickness of 210±44.8 µm in Group A and 235±124.7 µm in Group B. However, the mean average RNFL thickness at 6 months was 85±9 µm in Group A and 95±24 µm in Group B (p=0.6). The total duration of acetazolamide treatment was 188±209 days in Group A compared with 571±544 days in Group B (p=0.07). CONCLUSIONS: In subjects with venous sinuses stenosis, endovascular stenting offers an effective treatment option for intracranial hypertension which may shorten the duration of medical therapy.

Keywords

Angiography, CT Angiography, Stenosis, Stent

Medical Subject Headings

Adolescent; Adult; Cranial Sinuses (diagnostic imaging, surgery); Female; Follow-Up Studies; Humans; Intracranial Hypertension (diagnostic imaging, physiopathology, surgery); Intracranial Pressure (physiology); Middle Aged; Phlebography (methods); Retrospective Studies; Stents; Tomography, Optical Coherence (methods); Treatment Outcome; Young Adult

Publication Date

3-1-2018

Publication Title

Journal of neurointerventional surgery

E-ISSN

1759-8486

Volume

10

Issue

3

First Page

310

Last Page

314

PubMed ID

28487359

Digital Object Identifier (DOI)

10.1136/neurintsurg-2017-013103

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