Global collapse of the dural sinuses after venous stenting in idiopathic intracranial hypertension

2021 ◽  
pp. jnnp-2020-325717
Author(s):  
Alice Kedra ◽  
Mounir Lahlouh ◽  
Eimad Shotar ◽  
Yasmina Chenoune ◽  
Lucas Boistard ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Stenting ◽  
Dural Sinuses ◽  
Global Collapse

Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis

2018 ◽  
Vol 11 (4) ◽  
pp. 380-385 ◽  
Author(s):  
Patrick Nicholson ◽  
Waleed Brinjikji ◽  
Ivan Radovanovic ◽  
Christopher Alan Hilditch ◽  
Anderson Chun On Tsang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Meta Analysis ◽  
Venous Sinus ◽  
Pulsatile Tinnitus ◽  
Venous Stenting ◽  
Excellent Safety Profile ◽  
The Mean ◽  
Rate Of Improvement

BackgroundStenting of the intracranial venous sinuses is used as a treatment in certain cases of idiopathic intracranial hypertension (IIH). Interest in, and experience of, this technique is growing, particularly in recent years. We sought to provide an updated systematic review and meta-analysis of the use of venous stenting in these patients, examining clinical outcomes.MethodsA literature search of venous stenting in IIH patients was performed. Using random-effects meta-analysis, we evaluated the following outcomes: clinical resolution of papilledema; headaches and pulsatile tinnitus; recurrence of symptoms after stenting; and complications.ResultsTwenty articles from 18 different centers were included. In a total of 474 patients. 418 were female (88%). The mean age of the patients was 35, while the mean body mass index (BMI) was 35 kg/m2. Median follow-up was 18 months. The overall rate of improvement in papilloedema was 93.7% (95% CI 90.5% to 96.9%), while the overall rate of improvement or resolution of headache was 79.6% (95% CI 73.3% to 85.9%). Pulsatile tinnitus resolved in 90.3% (95% CI 83.8% to 96.70%), while the overall rate of recurrence of IIH symptoms after stenting was 9.8% (95% CI 6.7% to 13%). The rate of major complications was 1.9% (95% CI 0.07% to 3.1%).ConclusionsVenous sinus stenting in patients with IIH who are refractory to medical therapy appears to have an excellent safety profile and is associated with significant improvements in headaches, pulsatile tinnitus, and papilledema.

scholarly journals Transverse venous stenting for the treatment of idiopathic intracranial hypertension, or pseudotumor cerebri

2018 ◽  
Vol 45 (1) ◽  
pp. E11 ◽  
Author(s):  
Justin M. Cappuzzo ◽  
Ryan M. Hess ◽  
John F. Morrison ◽  
Jason M. Davies ◽  
Kenneth V. Snyder ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Venous Stenting ◽  
Shunt Placement ◽  
The Mean ◽  
Visual Disturbances

OBJECTIVEIdiopathic intracranial hypertension (IIH) is a commonly occurring disease, particularly among young women of child-bearing age. The underlying pathophysiology for this disease has remained largely unclear; however, the recent literature suggests that focal outflow obstruction of the transverse sinus may be the cause. The purpose of this study was to report one group’s early experience with transverse venous sinus stenting in the treatment of IIH and assess its effectiveness.METHODSThe authors performed a retrospective chart review to identify patients who had undergone stenting of an outflow-obstructed transverse venous sinus for the treatment of IIH at Gates Vascular Institute between January 2015 and November 2017. Patient demographic data of interest included age, sex, BMI, and history of smoking, hypertension, obstructive sleep apnea, hormonal contraceptive use, and acetazolamide therapy. Each patient’s presenting signs and symptoms and whether those symptoms improved with treatment were reviewed. The average opening lumbar puncture (LP) pressure preprocedure, average pressure gradient across the obstructed segment prior to stenting, treatment failure rate (need for shunt placement), and mean follow-up period were calculated.RESULTSOf the 18 patients who had undergone transverse venous stenting for IIH, 16 (88.9%) were women. The mean age of all the patients was 38.3 years (median 38 years). Mean BMI was 34.2 kg/m2 (median 33.9 kg/m2). Presenting symptoms were headache (16 patients [88.9%]), visual disturbances (13 patients [72.2%]), papilledema (8 patients [44.4%]), tinnitus (3 patients [16.7%]), and auditory bruit (3 patients [16.7%]). The mean opening LP pressure pre-procedure was 35.6 cm H2O (median 32 cm H2O). The mean pressure gradient measured proximally and distally to the area of focal obstruction within the transverse sinus was 16.5 cm H2O (median 15 cm H2O). Postprocedurally, 14 patients (77.8%) continued to have headaches; 6 (33.3%) continued to have visual disturbances. No patients continued to have auditory bruit (0%) or papilledema (0%). One patient (5.6%) had new-onset tinnitus postprocedure. Overall improvement of symptoms was noted in 16 patients (88.9%) postprocedure, with 1 patient (5.6%) requiring shunt placement and 2 other patients (11.1%) requiring postprocedural LP to monitor intracranial pressure to determine candidacy for further surgical interventions to treat residual symptoms. The mean duration of follow-up was 194.2 days.CONCLUSIONSTransverse sinus stenting is a rapidly developing technique that has shown good effectiveness and safety in the literature. Authors of the present study found that stenting a flow-obstructed transverse sinus in patients with IIH was a safe and effective way to treat the condition.

scholarly journals Severe cerebellar hemorrhage following transverse sinus stenting for idiopathic intracranial hypertension

2017 ◽  
Vol 24 (1) ◽  
pp. 100-105 ◽  
Author(s):  
Pascale Lavoie ◽  
Marie-Ève Audet ◽  
Jean-Luc Gariepy ◽  
Martin Savard ◽  
Steve Verreault ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Obstructive Hydrocephalus ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Level Of Evidence ◽  
Cerebellar Hemorrhage ◽  
Venous Stenting ◽  
Brainstem Reflex ◽  
Cerebral Mri

We report a severe adverse event occurring in the course of a cohort study (ISRCTN13784335) aimed at measuring the efficacy and safety of venous stenting in the treatment of patients with medically refractory idiopathic intracranial hypertension (IIH). The patient was a 41-year-old woman who was not overweight, who presented with severe headache, grade 1 bilateral papilledema and transient tinnitus, refractory to medical treatment. Right transverse sinus stenting was successfully performed. Following surgery, the patient’s state of consciousness decreased acutely with rapid and progressive loss of brainstem reflex. CT scan revealed acute cerebellar and intraventricular hemorrhage with obstructive hydrocephalus. Angioscan revealed normal venous sinus patency and cerebral MRI showed acute mesencephalic ischemia. Mechanical impairment of cerebellar venous drainage by the stent or venous perforation with the large guidewire used in this technique are two logical ways to explain the cerebellar hemorrhage seen in our patient. The risk of such a complication could probably be reduced using alternative tools and technique. However, given the low level of evidence around the safety of transverse sinus stenting in IIH, its formal assessment in clinical trials is required.

scholarly journals Stent Survival and Stent-Adjacent Stenosis Rates following Venous Sinus Stenting for Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 7 (6) ◽  
pp. 490-500 ◽  
Author(s):  
Hamidreza Saber ◽  
Whitfield Lewis ◽  
Mahsa Sadeghi ◽  
Gary Rajah ◽  
Sandra Narayanan
Keyword(s):  
Systematic Review ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Meta Analysis ◽  
Case Series ◽  
Causative Factor ◽  
Neurological Complications ◽  
Venous Sinus ◽  
Venous Stenting

Background: Idiopathic intracranial hypertension (IIH) is characterized by an elevated intracranial pressure without any identifiable causative factor such as an intracranial mass. Dural venous sinus stenosis (DVSS) has been suggested to be associated with IIH. Objective: We performed an updated systematic review and meta-analysis to determine clinical outcomes as well as stent survival and stent-adjacent stenosis rates in patients undergoing DVSS for the management of medically refractory IIH. Methods: We searched PubMed, Embase, and Cochrane databases to identify prospective or retrospective cohorts or case series of patients with IIH treated with DVSS between 2000 and 2017. Results: A total of 473 patients were included from 24 studies. Headache was present in 429 (91.8%) patients and resolved or improved in 319/413 (77.2%) after the procedure. Headache, papilledema, visual acuity, and tinnitus improved in 256/330 (77.6%), 247/288 (85.8%), 121/172 (70.3%), and 93/110 (84.5%) patients following DVSS at the final follow-up (mean of 18.3 months). In a meta-analysis of 395 patients with available follow-up data on stenting outcome (mean of 18.9 months), the stent survival and stent-adjacent stenosis rates were 84% (95% confidence interval [CI] 79–87%) and 14% (95% CI 11–18%), respectively. The rate of major neurological complications was less than 2%. Conclusion: Stent-adjacent stenosis is an important complication following venous stenting in patients with DVSS and IIH. Further studies are needed to identify determinants of stent-adjacent stenosis and stent nonsurvival.

Effect of venous stenting on intracranial pressure in idiopathic intracranial hypertension

2017 ◽  
Vol 159 (8) ◽  
pp. 1429-1437 ◽  
Author(s):  
Samir A. Matloob ◽  
Ahmed K. Toma ◽  
Simon D. Thompson ◽  
Chee L. Gan ◽  
Fergus Robertson ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Stenting

Safety and efficacy of intravascular ultrasound as an adjunct to stenting for cerebral venous sinus stenosis–induced idiopathic intracranial hypertension: a pilot study

2020 ◽  
Vol 132 (3) ◽  
pp. 749-754 ◽  
Author(s):  
Feng Yan ◽  
Gary Rajah ◽  
Yuchuan Ding ◽  
Yang Hua ◽  
Hongqi Zhang ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Intravascular Ultrasound ◽  
Stent Placement ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Sinus ◽  
Wall Thickening ◽  
Venous Stenting ◽  
Venous Stenosis ◽  
Sinus Stenosis

OBJECTIVESymptomatic intracranial hypertension can be caused by cerebral venous sinus stenosis (CVSS) and cerebral venous sinus thrombotic (CVST) stenosis, which is usually found in some patients with idiopathic intracranial hypertension (IIH). Recently, at the authors’ center, they utilized intravascular ultrasound (IVUS) as an adjunct to conventional venoplasty or stenting to facilitate diagnosis and accurate stent placement in CVSS.METHODSThe authors designed a retrospective review of their prospective database of patients who underwent IVUS-guided venous sinus stenting between April 2016 and February 2017. Clinical, radiological, and ophthalmological information was recorded and analyzed. IVUS was performed in 12 patients with IIH (9 with nonthrombotic CVSS, 3 with secondary stenosis combined with CVST) during venoplasty through venous access. The IVUS catheter was used from a proximal location to the site of stenosis. Post-stenting follow-up, including symptomatic improvement, stent patency, and adjacent-site stenosis, was assessed at 1 year.RESULTSThirteen stenotic cerebral sinuses in 12 patients were corrected using IVUS-guided stenting. No technical or neurological complications were encountered. The IVUS images were excellent for the diagnosis of the stenosis, and intraluminal thrombi were clearly visualized by using IVUS in 3 (25%) of the 12 patients. A giant arachnoid granulation was demonstrated in 1 (8.3%) of the 12 patients. Intravenous compartments or septations (2 of 12, 16.7%) and vessel wall thickening (6 of 12, 50%) were also noted. At 1-year follow-up, 10 of 12 patients were clinically symptom-free in our series.CONCLUSIONSIVUS is a promising tool with the potential to improve the diagnostic accuracy in IIH, aiding in identification of the types of intracranial venous stenosis, assisting in stent selection, and guiding stent placement. Further study of the utility of IVUS in venous stenting and venous stenosis pathology is warranted.

scholarly journals Mastoiditis caused by intracranial venous sinus stenting in an idiopathic intracranial hypertension patient

2019 ◽  
Vol 25 (4) ◽  
pp. 478-480
Author(s):  
Linyu Tian
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Venous Stenting ◽  
Cerebrospinal Fluid Diversion ◽  
Optic Nerve Sheath Fenestration ◽  
Dural Venous Sinus ◽  
First Time ◽  
Idiopathic Intracranial Hypertension Patient

The exact mechanism of idiopathic intracranial hypertension (IIH) is unknown. It needs to be treated because of severe headache and impaired vision. For medically refractory patients, cerebrospinal fluid diversion, optic nerve sheath fenestration and dural venous sinus stenting is applied to relieve the symptoms. As a new therapy, the complication of dural venous stenting was a focus for operators. Here, a woman is reported with IIH who suffered from mastoiditis after stenting in the sigmoid sinus for the first time. The special local anatomy of the sigmoid sinus adjacent to the inner structure made it a noteworthy complication.

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