Endovascular treatment of debilitating tinnitus secondary to cerebral venous sinus abnormalities: a literature review and technical illustration

2019 ◽  
Vol 11 (8) ◽  
pp. 841-846 ◽  
Author(s):  
I-Hsiao Yang ◽  
Vitor M Pereira ◽  
Stephanie Lenck ◽  
Patrick Nicholson ◽  
Emanuele Orru ◽  
...  
Keyword(s):  
Literature Review ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Therapeutic Option ◽  
Jugular Bulb ◽  
Venous Sinus ◽  
Illustrative Case ◽  
Endovascular Interventions ◽  
Sinus Stenosis ◽  
Cerebellar Infarct

Background and objectivePulsatile tinnitus (PT) can be debilitating and lead to significant morbidity. Cerebral venous sinus lesions, such as venous sinus stenosis, diverticula, and high-riding jugular bulb, are uncommon causes of PT, for which there is no standard treatment. Endovascular interventions have shown promising results for PT secondary to idiopathic intracranial hypertension, and may be a valid therapeutic option for isolated venous PT.MethodsWe conducted a systematic literature review on the outcome and safety of endovascular treatment for patients with isolated, debilitating venous PT. The venous lesion characteristics, endovascular techniques, complications, and clinical outcomes were assessed. In addition, an illustrative case of endovascular stenting for PT caused by venous sinus stenosis was included.ResultsA total of 41 patients (90.2% female) from 26 papers were included. The median age was 46 years (IQR 23; range 25–72 years). Focal venous sinus stenosis (20 patients) and sinus diverticula (14 patients) were the most common culprit lesions. Endovascular treatment included venous sinus stenting in 35 patients, 11 of whom had adjuvant coil embolization, and coil embolization alone in six patients. Complete resolution of the tinnitus was achieved in 95.1% of patients. There was one complication of cerebellar infarct, and no procedure-related mortality.ConclusionsIn patients with debilitating PT secondary to venous sinus lesions, endovascular treatment by stenting and/or coil embolization appears to be safe and effective. Prospective randomized studies with objective outcome assessments are needed to confirm the treatment benefits.

Venous Sinus Stenosis Treatment in Pediatric Idiopathic Intracranial Hypertension: Illustrative Case and Literature Review

2021 ◽  
Author(s):  
Lacey M. Carter ◽  
Arpan R. Chakraborty ◽  
Tressie M. McCoy ◽  
Allison E. Strickland ◽  
Bradley N. Bohnstedt ◽  
...  
Keyword(s):  
Literature Review ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Sinus ◽  
Illustrative Case ◽  
Sinus Stenosis

Nuances of Endovascular Treatment of Transverse/Sigmoid Sinus Stenosis With Stenting Venoplasty in a Patient With Pseudotumor Cerebri: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. 393-394
Author(s):  
Leonardo Rangel-Castilla ◽  
Adnan H Siddiqui
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Venous Pressure ◽  
Pseudotumor Cerebri ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Chronic Obstructive ◽  
Guide Catheter ◽  
Patient Consent ◽  
Sinus Stenosis

Abstract We present a case of a patient with pseudotumor cerebri (PC) and transverse/sigmoid junction sinus (TSJS) stenosis treated with stenting venoplasty. A 54-yr-old man with a history of hypertension, hyperlipidemia, and chronic obstructive pulmonary disease presented with subacute onset of progressive headaches, blurred vision, and papilledema. He was clinically diagnosed with PC. Left TSJS stenosis was suspected on magnetic resonance venography and confirmed with digital subtraction angiography and venography. During angiography, venous pressures were measured along the intracranial venous system revealing a significant drop compared with pressures obtained from the superior sagittal and sigmoid sinuses. For 7 d prior to venous sinus stenting, he was prescribed antiplatelet therapy with aspirin (350 mg/d) and clopidogrel (75 mg/d). Patient consent was obtained prior to performing the procedure; institutional board approval is not required for the report of a single case. Under conscious sedation and systemic heparinization, the patient underwent endovascular stenting of the left TSJS with an open-cell carotid stent (Precise 7 × 40 mm; Cordis, Milpitas, California). Successful left TSJS reconstruction transpired with no procedure-related complications. The patient was discharged home 1 d postprocedure. After 2 mo of dual antiplatelet therapy, clopidogrel was discontinued. At the 1-yr follow-up, he had resolution of papilledema and notably less intense headaches. Venous sinus stenting is an effective endovascular treatment for symptomatic patients with PC and sinus stenosis. Venous pressure measurement is imperative for patient selection. Adequate venous access with a 6-French guide catheter into the sigmoid sinus and an intermediate catheter into the transverse sinus is crucial to navigate a stent through the acute angles of the TSJS and jugular vein.

Efficacy of stenting in patients with cerebral venous sinus thrombosis-related cerebral venous sinus stenosis

2018 ◽  
Vol 11 (3) ◽  
pp. 307-312 ◽  
Author(s):  
Ke Li ◽  
Ming Ren ◽  
Ran Meng ◽  
Yuchuan Ding ◽  
Gary B Rajah ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Therapeutic Option ◽  
Visual Disturbance ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Chronic Stage ◽  
Venous Sinus Thrombosis ◽  
Venous Stenting ◽  
Long Term Study ◽  
Sinus Stenosis

BackgroundVenous stenting has been proven to be a safe and effective therapeutic option for patients with idiopathic intracranial hypertension (IIH) and cerebral venous sinus stenosis (CVSS). However, its use in patients with cerebral venous sinus thrombosis-related CVSS has been less reported.PurposeTo explore the safety and efficacy of stenting for patients with cerebral venous sinus thrombosis (CVST)-related CVSS.MethodsThe clinical presentation, treatment, and outcome of patients with CVST-related CVSS received venous stenting in the chronic stage after failed medical treatment were retrospectively evaluated.ResultsA total of 17 patients with CVST-related CVSS were included. Mean pressure gradient across the CVSS decreased from 11.5±4.2 mmHg prior to stenting to 2.1±1.1 mmHg post- stenting. Mean CSF opening pressure decreased from 33.1±5.5 cmH2O to 18.7±1.7 cmH2O. Both headache and visual disturbance improved or resolved in 78% and 92% of the patients, respectively. Complications included lethal cerebellar hematoma in one case and bilateral occipital epidural hematoma in another case. One of the patients received retreatment with ventriculo-peritoneal shunting due to recurrent headache.ConclusionRestoring the patency of stenotic sinuses with stents in patients of CVST-related CVSS unresponsive to medical therapy in the chronic stage may improve symptoms in the majority of the patients. However, a relatively higher cerebral hemorrhage rate was observed and may be related to this pathology. Stenting in this subgroup of CVSS patients may require further evaluation with a larger and long-term study, and should be used with caution at this time.

Endovascular Treatment of Cerebral Venous Sinus Stenosis Based on Hemodynamic Assessment Using Pressure Wire

2020 ◽  
Vol 136 ◽  
pp. 323-325
Author(s):  
Rui Liu ◽  
Rui Sun ◽  
Feihong Huang ◽  
Yunfei Han ◽  
Ping Zheng ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Venous Sinus ◽  
Pressure Wire ◽  
Hemodynamic Assessment ◽  
Sinus Stenosis

Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting

2018 ◽  
Vol 10 (12) ◽  
pp. 1203-1208 ◽  
Author(s):  
Kyle M Fargen ◽  
Kenneth Liu ◽  
Rebecca M Garner ◽  
Garret P Greeneway ◽  
Stacey Q Wolfe ◽  
...  
Keyword(s):  
Literature Review ◽  
Intracranial Hypertension ◽  
Treatment Option ◽  
Patient Selection ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Sinus ◽  
Extensive Literature ◽  
Level Of Evidence ◽  
Sinus Stenosis ◽  
Diagnostic Catheter

IntroductionAlthough venous sinus stenting (VSS) has emerged as a promising treatment option for patients with idiopathic intracranial hypertension (IIH) and associated venous sinus stenosis, there is considerable ambiguity regarding patient selection criteria, treatment protocols, and management strategies.MethodsAn extensive literature review was performed to identify all reports of VSS in patients with IIH using PubMed. Recommendations for the selection and treatment of patients with IIH with VSS are outlined as determined based on author opinion from supporting studies. Due to the lack of randomized trials and few published prospective studies, standard grading scales for recommendations and level of evidence are not fully applicable and therefore a revised grading scale has been provided for recommendations.ResultsThe literature review identified a total of eight systematic reviews or meta-analyses and 29 published patient series on VSS. Recommendations for patient selection for diagnostic catheter angiography, angiography procedural considerations, stenting procedural considerations, and retreatment are provided based on the literature. Recommendations that were considered strong included: performance of venous sinus manometry to assess candidacy for treatment prior to stenting; administration of antiplatelet agents prior to stenting and for a follow-up period of at least 3–6 months; performance of post-stenting manometry to confirm resolution of pressure gradient; and performance of repeat angiography and manometry on patients with recurrence of symptoms after resolution with stenting to evaluate for recurrent stenosis.ConclusionVSS for patients with IIH with venous sinus stenosis is now an established and effective treatment option. These recommendations have been provided, based on a summative review of the available published literature, to assist in standardizing care for patients with IIH undergoing VSS.

scholarly journals Endovascular Treatment of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension: Complications, Neurological Outcomes, and Radiographic Results

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Robert M. Starke ◽  
Tony Wang ◽  
Dale Ding ◽  
Christopher R. Durst ◽  
R. Webster Crowley ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Therapeutic Option ◽  
Venous Pressure ◽  
Venous Sinus ◽  
Venous Stenting ◽  
Neurological Outcomes ◽  
Effective Therapeutic Option ◽  
Sinus Stenosis

Introduction.Idiopathic intracranial hypertension (IIH) may result in a chronic debilitating disease. Dural venous sinus stenosis with a physiologic venous pressure gradient has been identified as a potential etiology in a number of IIH patients. Intracranial venous stenting has emerged as a potential treatment alternative.Methods. A systematic review was carried out to identify studies employing venous stenting for IIH.Results. From 2002 to 2014, 17 studies comprising 185 patients who underwent 221 stenting procedures were reported. Mean prestent pressure gradient was 20.1 mmHg (95% CI 19.4–20.7 mmHg) with a mean poststent gradient of 4.4 mmHg (95% CI 3.5–5.2 mmHg). Complications occurred in 10 patients (5.4%; 95% CI 4.7–5.4%) but were major in only 3 (1.6%). At a mean clinical follow-up of 22 months, clinical improvement was noted in 130 of 166 patients with headaches (78.3%; 95% CI 75.8–80.8%), 84 of 89 patients with papilledema (94.4%; 95% CI 92.1–96.6%), and 64 of 74 patients with visual symptoms (86.5%; 95% CI 83.0–89.9%). In-stent stenosis was noted in six patients (3.4%; 95% CI 2.5–4.3%) and stent-adjacent stenosis occurred in 19 patients (11.4%; 95% CI 10.4–12.4), resulting in restenting in 10 patients.Conclusion. In IIH patients with venous sinus stenosis and a physiologic pressure gradient, venous stenting appears to be a safe and effective therapeutic option. Further studies are necessary to determine the long-term outcomes and the optimal management of medically refractory IIH.

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