Unilateral Transverse Sinus Stenting of Patients with Idiopathic Intracranial Hypertension

• Published in: American journal of neuroradiology : AJNR 2010-04, Vol.31 (4), p.645-650
• Main Authors: BUSSIERE, M, FALERO, R, NICOLLE, D, PROULX, A, PATEL, V, PELZ, D
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Body Mass Index; Cerebral Angiography; Constriction, Pathologic - diagnosis; Constriction, Pathologic - therapy; Female; Follow-Up Studies; Human viral diseases; Humans; Infectious diseases; Interventional; Intracranial Pressure; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging; Manometry; Medical sciences; Middle Aged; Nervous system; Neurologic Examination; Obesity, Morbid - complications; Optic Atrophy - etiology; Pseudotumor Cerebri - diagnosis; Pseudotumor Cerebri - therapy; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Stents; Transverse Sinuses; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Young Adult
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A1890

The pathophysiology of IIH remains unknown. TS stenoses have been observed in a high proportion of these patients. Stent placement to remove this potential obstruction to venous outflow has been proposed as a treatment option for patients with IIH refractory to medical treatment. The clinical presentation, treatment, and outcome of patients with refractory IIH evaluated for venous sinus stent placement at a tertiary care center was retrospectively reviewed. Thirteen female patients with IIH were evaluated for sinovenous stent placement. Moderate sinus stenoses with normal intrasinus pressures were found in 3 patients and therefore stent placement was not performed. Ten patients had elevated intrasinus pressures (pressure gradient across stenosis, 11-50 mm Hg), which decreased following unilateral TS stent placement. Headaches improved or resolved in all stented patients. Papilledema resolved completely or almost completely in 8 patients and significantly improved in 2 patients. One patient developed optic atrophy. There were no major periprocedural complications. In this small case series, restoring the patency of stenotic venous sinuses with a stent in patients with refractory IIH resulted in symptomatic improvement in all treated patients. The safety and efficacy of this procedure should be evaluated in a randomized controlled study to determine its role within the armamentarium of therapeutic options for patients with IIH.