Dural venous sinus stenting in patients with idiopathic intracranial hypertension: report of outcomes from a single-center prospective database and literature review

ABSTRACT

Introduction

Idiopathic intracranial hypertension (IIH) is a disease of excess cerebrospinal fluid (CSF) leading to rising intracranial pressure. Patients most commonly present with headache, tinnitus, papilledema, and vision loss. It most commonly affects young overweight females, a growing population. Traditional management has consisted of weight loss, medical management, surgical CSF diversion, and optic nerve sheath fenestration. In recent years, cerebral venous sinus stenosis has been described as an almost ubiquitously present potentiator of this disease. Venous sinus stenting to normalize cerebral venous outflow has emerged as a highly effective treatment.

Areas covered

In this review, the authors review the epidemiology and pathophysiology of IIH, as well as its common management strategies. The authors focus on the emergence of venous sinus stenting as a safe, effective, and minimally invasive strategy for managing IIH.

Expert opinion

IIH caused by venous sinus stenosis can be treated effectively and safely with endovascular stenting of the sinus. Given its low morbidity and failure rate relative to other traditional management strategies, evaluation for venous sinus stenosis should be pursued in this patient population, and referral to a neuro-endovascular specialist made if indicated.

KEYWORDS:

• Pseudotumor
• idiopathic intracranial hypertension
• venous sinus stenosis
• papilledema

Article highlights

• Cerebral venous sinus stenosis is commonly identified in patients with idiopathic intracranial hypertension (IIH)

• Cerebral venous sinus stenosis can cause elevated intracranial pressure, leading to papilledema, headaches, and vision loss

• Traditional management strategies for IIH (CSF shunting, optic nerve sheath fenestration, acetazolamide, bariatric surgery) can be morbid and/or not well-tolerated

• Cerebral venous sinus stenting is a safe, effective, and minimally invasive management strategy in patients with IIH and venous sinus stenosis

Declaration of interest

PR Chen is awarded a grant from Stryker Neurovascular, which did not supply funding for any of this work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethical approval

Patients at the author’s own institution were examined, in concordance with their Institutional Review Board. This information was collected pre-treatment, and repeatedly at regular time intervals during follow-up. Consent for placement in the registry was waived by the Institutional Review Board, as it did not constitute any additional intervention, time spent, or additional risk of harm to patients.

Additional information

Funding

Funding was supplied by the Weatherhead Foundation (PR Chen).