Traitement endovasculaire de l'hypertension intracrânienne bénigne étiquetée « idiopathique ». Analyse de huit cas consécutifs

• Published in: Neuro-chirurgie 2007, Vol.53 (1), p.10-17
• Main Authors: Metellus, P, Levrier, O, Fuentes, S, N'Doye, N, Laghmari, M, Adetchessi, T, Dufour, H, Donnet, A, Conrath, J, Grisoli, F
• Format: Article
• Language: fre
• Subjects: Benign intracranial hypertension; Chirurgie (generalites). Transplantations, greffes d'organes et de tissus. Pathologie des greffons; Chirurgie du système nerveux; Direct retrograde cerebral venography; Endovascular stenting; Neurosurgery; Sciences biologiques et medicales; Sciences medicales; Sinus lateral stenosis; Surgery
• ISSN: 0028-3770; 1773-0619
• DOI: 10.1016/j.neuchi.2006.10.003

Abstract Introduction Optic nerve sheath fenestration or ventricular shunting are classically proposed after failure of medical treatment. Idiopathic intracranial hypertension is caused by venous sinus obstruction in an unknown percentage of cases. Recently, endoluminal venous sinus stenting was proposed as an alternative treatment. Patients and method Between September 2003 and December 2004, eight consecutive patients with a diagnosis of idiopathic intracranial hypertension underwent MRI venography and direct retrograde cerebral angiography. Results There were five females and three males aged 22 to 55 years. All patients had vision disorders. The cerebrospinal fluid pressure ranged from 27 to 45 mmHg with normal composition. All patients presented at least one sinus stenosis. Endovascular stenting of the stenotic venous sinus was performed under intravenous heparin administration. Anti-platelet therapy was administered for 3 months post treatment. Intra-sinus pressures were invariably reduced by stenting. Mean follow-up was 18 months. All patients improved clinically. The cerebrospinal fluid pressure had normalized at 3-month follow-up in all patients. In all patients, multidetector row CT-angiography or MRI venography was performed at 3-, 6- and 12-month follow-up and demonstrated the patency of the stent. Discussion The importance of venous sinus disease as a cause of idiopathic intracranial hypertension is probably underestimated. Patients with idiopathic intracranial hypertension should be evaluated with direct retrograde cerebral venography and manometry. In patients with venous sinus lesions, treatment by an endoluminal venous sinus stent is a safe and effective alternative for amenable lesions.