scholarly journals Endovascular Treatment for Idiopathic Intracranial Hypertension Improves Clinical Symptoms and Signs

2017 ◽  
Vol 36 (01) ◽  
pp. 01-06
Author(s):  
João Silva ◽  
Mario Conti ◽  
Guilherme Aguiar ◽  
Mauricio Jory ◽  
Paulo Monzillo ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Clinical Symptoms ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Pressure Gradients ◽  
Sinus Stenosis ◽  
Symptoms And Signs

Introduction New physiopathological concepts regarding idiopathic intracranial hypertension (IIH) recommend the endovascular treatment in refractory patients with transverse sinus stenosis. Objectives To assess the role of the transverse sinus stenting treatment in the symptomatology of patients with IIH. Method Clinically refractory patients with impaired venous drainage of the transverse sinus were submitted to cerebral angiographies. Patients with pre and post-stenotic pressure gradients > 8 mmHg were submitted to endovascular treatment. Results Seven patients underwent cerebral angiography with manometry. Stenting was performed in six cases after pressure gradient assessment. All cases showed improvements in headache and resolution of papilledema. Discussion and Conclusion Although the role of endovascular therapy should be further studied, our data suggest it may improve the clinical symptoms and signs of IIH in selected patients.

scholarly journals Transient resolution of venous sinus stenosis after high-volume lumbar puncture in a patient with idiopathic intracranial hypertension

2018 ◽  
Vol 129 (1) ◽  
pp. 153-156 ◽  
Author(s):  
Thomas J. Buell ◽  
Daniel M. S. Raper ◽  
I. Jonathan Pomeraniec ◽  
Dale Ding ◽  
Ching-Jen Chen ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Intracranial Hypertension ◽  
Lumbar Puncture ◽  
Idiopathic Intracranial Hypertension ◽  
High Volume ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Pressure Gradients ◽  
Cross Sectional ◽  
Sinus Stenosis

Stenosis of the transverse sinus (TS) and sigmoid sinus (SS), with a trans-stenosis pressure gradient, has been implicated in the pathophysiology of idiopathic intracranial hypertension (IIH). MRI has shown improvement in TS and SS stenosis after high-volume lumbar puncture (HVLP) in a subset of patients with IIH. The authors present the first report of an IIH patient with immediate post-HVLP TS and SS trans-stenosis pressure gradient reduction and an attendant increase in TS and SS cross-sectional area confirmed using intravascular ultrasonography (IVUS). Recurrence of the patient’s TS-SS stenosis coincided with elevated HVLP opening pressure, and venous sinus stent placement resulted in clinical improvement. This report suggests that TS and SS stenosis may be a downstream effect of elevated intracranial pressure in IIH, rather than its principal etiological mechanism. However, the authors hypothesize that endovascular stenting may obliterate a positive feedback loop involving trans-stenosis pressure gradients, and still benefit appropriately selected patients.

scholarly journals Endovascular Treatment of Idiopathic Intracranial Hypertension with Stenting of the Transverse Sinus Stenosis

2018 ◽  
Vol 13 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Shigeru Miyachi ◽  
Ryo Hiramatsu ◽  
Hiroyuki Ohnishi ◽  
Kenkichi Takahashi ◽  
Toshihiko Kuroiwa
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Transverse Sinus ◽  
Sinus Stenosis

A new index for the assessment of transverse sinus stenosis for diagnosing idiopathic intracranial hypertension

2016 ◽  
Vol 9 (2) ◽  
pp. 173-177 ◽  
Author(s):  
Gustavo Balthazar da Silveira Carvalho ◽  
Sandro Luiz de Andrade Matas ◽  
Marcos Hideki Idagawa ◽  
Luiz Antônio Tobaru Tibana ◽  
Renato Sartori de Carvalho ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Characteristic Curve ◽  
Transverse Sinus ◽  
Control Group ◽  
Group Index ◽  
Sinus Stenosis ◽  
The Right ◽  
Sensitivity Specificity

Background and purposeTo assess the role of MR venography (MRV) for detecting transverse sinus stenosis, to determine the importance of this finding in idiopathic intracranial hypertension (IIH), and to propose an index that contributes to this diagnosis.Materials and methodsWe retrospectively assessed consecutive intracranial MRV of patients aged >18 years diagnosed with IIH according to the diagnostic criteria, between January 2010 and July 2012. The assessments were randomly analyzed by three radiologists. Stenoses in the right and left transverse sinuses were independently classified according to the following scale: 0, normal; 1, stenosis <33%; 2, stenosis 33–66%; 3, stenosis >66%; and 4, hypoplasia or agenesis. We established an index based on multiplication of the stenosis scale values for each transverse sinus. A point and range estimate of the sensitivity, specificity, and the area under the receiver operating characteristic curve was performed to obtain cut-off points to differentiate between controls and patients.Results63 individuals were included in this study: 32 (50.8%) diagnosed with IIH (31 (96.9%) women and 1 (3.1%) man) and 31 (49.2%) controls. According to all of the examiners, the IIH group showed a higher degree of stenosis than the control group. Index values ≥4 for a diagnosis of IIH had a sensitivity and specificity of 94.7% and 93.5%, respectively.ConclusionsMRV should be used to assess patients with suspected IIH, and bilateral transverse sinus stenosis should be considered for the diagnosis. The stenosis classifying index proposed here is a fast and accessible method for diagnosing IIH.

Prevalence of dural venous sinus stenosis and hypoplasia in a generalized population

2016 ◽  
Vol 8 (11) ◽  
pp. 1173-1177 ◽  
Author(s):  
Christopher R Durst ◽  
David A Ornan ◽  
Michael A Reardon ◽  
Prachi Mehndiratta ◽  
Sugoto Mukherjee ◽  
...  
Keyword(s):  
General Population ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Inclusion Criteria ◽  
Multivariate Statistical ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

Background and purposeWhile recent literature has described the prevalence of transverse sinus stenosis in patients with idiopathic intracranial hypertension, tinnitus, and refractory headaches, it is unclear what the prevalence is in the general population. This study evaluates the prevalence of venous sinus stenosis and hypoplasia in the general patient population.Materials and methods355 of 600 consecutive patients who underwent CT angiography of the head met the inclusion criteria. The diameters of the dural venous sinuses were recorded. Each study was evaluated by a neuroradiologist for the presence of stenoses. Univariate and multivariate statistical analyses were performed by a statistician.ResultsThe prevalence of unilateral transverse sinus stenosis or hypoplasia in a sample of patients representing the general population was 33%, the prevalence of bilateral transverse sinus stenosis was 5%, and the prevalence of unilateral stenosis with contralateral hypoplasia was 1%. A multivariate analysis identified arachnoid granulations as a predictor of stenosis (p<0.001). Gender trended toward significance (p=0.094). Race was not a significant predictor of stenosis (p=0.745).ConclusionsThe prevalence of bilateral transverse sinus stenosis in the general population is not trivial. These data may be used as a reference for understanding the mechanistic role of stenoses in idiopathic intracranial hypertension, tinnitus, and refractory headaches.

Reductions in bilateral transverse sinus pressure gradients with unilateral transverse venous sinus stenting for idiopathic intracranial hypertension

2020 ◽  
pp. neurintsurg-2020-016170
Author(s):  
Anthony Larson ◽  
Lorenzo Rinaldo ◽  
John J Chen ◽  
Jeremy Cutsforth-Gregory ◽  
Amy R Theiler ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Stent Placement ◽  
Idiopathic Intracranial Hypertension ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Pressure Gradients ◽  
Before And After ◽  
Sinus Stenosis ◽  
The Mean ◽  
The Right

BackgroundVenous sinus stenting is an effective treatment for papilledema associated with idiopathic intracranial hypertension (IIH). It is unclear whether unilateral transverse-sigmoid sinus (TSS) stenting adequately decompresses the contralateral TSS system in cases of bilateral transverse sinus stenosis. The objective of this study was to compare changes in bilateral TSS pressure gradients following unilateral TSS stenting in a series of patients with IIH.MethodsConsecutive patients from a single institution who underwent venous sinus stenting for IIH with measurement of bilateral pressure gradients before and after stenting for IIH were enrolled. Pressure gradients in both TSS pre- and post-stenting were measured during the procedure. The TSS with the highest gradient was stented. Changes in TSS pressure gradients following stent placement were calculated for both TSS. Mean changes in pressure gradients of ipsilateral and contralateral TSS were calculated.ResultsSixteen patients with IIH who underwent TSS stenting were included. All were female. Mean age was 36.4 years. The right-sided TSS was the stented side in 12 (75.0%) patients. The mean pre-stent pressure gradient of the ipsilateral TSS was 19.3 mmHg (SD=10.8), which was reduced to a mean of 3.8 mmHg (3.4) following stent placement (P =<0.0001). On the contralateral (non-stented) side, the mean pre-stent gradient of 15.1 mmHg (7.5) was reduced to a mean of 7.8 mmHg (6.6) following stenting (P=0.006).ConclusionsThe use of a single stent provides some venous decompression of the contralateral non-stented stenosis in most cases of IIH treated with endovascular therapy.

scholarly journals Endovascular treatment of idiopathic intracranial hypertension caused by multiple venous sinus stenoses

2019 ◽  
Vol 10 ◽  
pp. 47 ◽  
Author(s):  
Yudai Morisaki ◽  
Ichiro Nakagawa ◽  
Koji Omoto ◽  
Takeshi Wada ◽  
Kimihiko Kichikawa ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Hypertension ◽  
Stent Placement ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Pressure ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Sagittal Sinus ◽  
Sinus Stenosis ◽  
Cerebral Venous Pressure

Background: Idiopathic intracranial hypertension (IIH) shows symptoms by elevating intracranial pressure. Although sinus stenosis has been detected in many patients with IIH, the role of sinus stenosis in IIH remains obscure. Endovascular treatment for IIH due to transverse sinus stenosis has been frequently documented; however, IIH due to multiple sinus stenoses including the superior sagittal sinus (SSS) is rare. Here, we report a case of IIH due to multiple sinus stenoses treated by sinus stenting. Case Presentation: A 47-year-old woman suffered from intractable headache with IIH presented with stenosis of the right transverse and SSS. Stent placement was carried out since intracranial hypertension and trans-stenotic cerebral venous pressure gradient (CVPG) were presented, and her intractable headache disappeared. Conclusion: IIH can be caused by venous sinus stenoses and stent placement could be an appropriate treatment in patients who demonstrated a CVPG.

scholarly journals Intracranial Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Case Report and Review of the Literature

2021 ◽  
Vol 11 (3) ◽  
pp. 382
Author(s):  
Dinesh Ramanathan ◽  
Zachary D. Travis ◽  
Emmanuel Omosor ◽  
Taylor Wilson ◽  
Nikhil Sahasrabudhe ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Subdural Hygroma ◽  
Presenting Symptoms ◽  
Minimal Improvement ◽  
Sinus Stenosis ◽  
Work Up

We describe a case of severe headaches, double vision, and progressive vision loss secondary to a ruptured intracranial cyst (IAC) in a 31-year-old woman with no relevant past medical history. The case is peculiar because drainage of the subdural hygroma led to a minimal improvement in vision with persistent elevated intracranial pressure (ICP). Further exploration revealed transverse sinus stenosis necessitating stenting. Evaluation post-stenting showed marked reduction of ICP and improvement in symptoms. This report underscores the importance of comprehensive work-up and suspicion of multiple underlying etiologies that may be crucial to complete resolution of presenting symptoms in some cases. We provide an overview of the clinical indications and evidence for venous sinus stenting in treating idiopathic intracranial hypertension (IIH).

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