Dural venous sinus stenting for treatment of pediatric idiopathic intracranial hypertension

BackgroundDural venous sinus stenting (VSS) is an effective treatment for idiopathic intracranial hypertension (IIH) in adult patients. There are no published series to date evaluating safety and efficacy of VSS in pediatric patients.ObjectiveTo report on procedural device selection and technique as well as safety and efficacy of VSS for pediatric patients with medically refractory IIH due to underlying venous sinus stenosis.MethodsA multi-institutional retrospective case series identified patients with medically refractory IIH aged less than 18 years who underwent VSS.Results14 patients were identified at four participating centers. Patient ages ranged from 10 to 17 years, and 10 patients (71.4%) were female. Mean body mass index was 25.7 kg/m2 (range 15.8–34.6 kg/m2). Stenting was performed under general endotracheal anesthesia in all except two patients. The average trans-stenotic gradient during diagnostic venography was 10.6 mm Hg. Patients had stents placed in the superior sagittal sinus, transverse sinus, sigmoid sinus, occipital sinus, and a combination. Average follow-up was 1.7 years after stenting. Six patients out of 10 (60%) had reduced medication dosing, 12 of 14 patients (85.7%) had improvements in headaches, two patients (100%) with pre-stent tinnitus had resolution of symptoms, and four (80%) of five patients with papilledema had improvement on follow-up ophthalmological examinations. Two patients (14.3%) developed postprocedural groin hematomas, one patient (7.1%) developed a groin pseudoaneurysm, and one patient (7.1%) had postprocedural groin bleeding. No other procedural complications occurred. Four patients (28.6%) required further surgical treatment (cerebrospinal shunting and/or stenting) after their first stenting procedure.ConclusionsThis series suggests that VSS is feasible in a pediatric population with IIH and has a low complication rate and good clinical outcomes.

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Venous sinus stenting for idiopathic intracranial hypertension is not associated with cortical venous occlusion

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011692 ◽

2015 ◽

Vol 8 (6) ◽

pp. 594-595 ◽

Cited By ~ 15

Author(s):

Michael R Levitt ◽

Felipe C Albuquerque ◽

Andrew F Ducruet ◽

M Yashar S Kalani ◽

Celene B Mulholland ◽

...

Keyword(s):

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Venous Occlusion ◽

Venous Sinus ◽

Radiological Data ◽

Angiographic Data ◽

Intracranial Complications ◽

Dural Venous Sinus

BackgroundThe effect of dural venous sinus stenting has been investigated for the treatment of idiopathic intracranial hypertension (IIH) but the effect of stenting on the long-term patency of the cortical draining veins, especially the vein of Labbé (VOL), remains unknown.MethodsWe reviewed our database of 38 patients with IIH with 41 stented dural venous sinuses between October 2006 and December 2014. Demographic, clinical, and radiological data were reviewed. Follow-up catheter angiographic data were included when available.ResultsStent placement spanned the ostium of the VOL in 35 patients (92.1%), with no immediate effect on the drainage of the VOL. Follow-up angiography (mean 35.1 months, range 1.7–80.7 months) was available in 24 patients, 21 of whom had stents spanning the VOL ostium. The VOL remained patent without occlusion or drainage alteration in all 21 patients. There were no immediate or long-term intracranial complications.ConclusionsDural venous sinus stenting for patients with IIH does not affect the immediate or long-term patency of the VOL and is not associated with intracranial complications.

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Venous sinus stenting in patients without idiopathic intracranial hypertension

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012405 ◽

2016 ◽

Vol 9 (5) ◽

pp. 512-515 ◽

Cited By ~ 10

Author(s):

Michael R Levitt ◽

Felipe C Albuquerque ◽

Bradley A Gross ◽

Karam Moon ◽

Ashutosh P Jadhav ◽

...

Keyword(s):

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Sinus Thrombosis ◽

Venous Sinus ◽

Congenital Hydrocephalus ◽

Pulsatile Tinnitus ◽

Venous Sinus Thrombosis ◽

Sinus Stenosis ◽

Dural Venous Sinus

BackgroundVenous sinus stenting is an effective treatment for patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis.ObjectiveTo determine the usefulness of venous sinus stenting in the treatment of patients with symptomatic venous sinus stenosis without a diagnosis of IIH.MethodsWe performed a retrospective review of a prospective multicenter database of patients undergoing venous sinus stenting between January 2008 and February 2016. Patients with acute dural venous sinus thrombosis, arteriovenous fistula or arteriovenous malformation, or IIH were excluded. Clinical, radiological, and ophthalmological information was recorded.ResultsNine patients met the inclusion criteria and underwent venous sinus stenting for symptomatic dural venous sinus stenosis. Reasons for treatment included isolated unilateral pulsatile tinnitus (n=1), congenital hydrocephalus (n=2), unilateral pulsatile tinnitus following prior venous sinus thrombosis (n=1), acquired hydrocephalus following dural sinus thrombosis (n=2), meningitis (n=2) and tumor invasion into the dural venous sinus (n=1). Six patients underwent lumbar puncture or shunt tap, and all of these patients had elevated intracranial pressure. All stenoses were located in the transverse sinus, transverse–sigmoid junction and/or jugular bulb, and all were treated with self-expanding bare-metal stents. At follow-up, clinical symptoms had resolved in all but two patients, both of whom had congenital hydrocephalus and pre-existing shunts. There was no significant in-stent stenosis, and patients with ophthalmological follow-up demonstrated improvement of papilledema.ConclusionsDural venous sinus stenting may be an effective treatment for patients with symptomatic venous sinus stenosis without IIH in carefully selected cases, but may not be effective in resolving the symptoms of congenital hydrocephalus.

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Dural venous sinus stenting for medically and surgically refractory idiopathic intracranial hypertension

Interventional Neuroradiology ◽

10.1177/1591019916680110 ◽

2017 ◽

Vol 23 (2) ◽

pp. 186-193 ◽

Cited By ~ 14

Author(s):

Sudhakar R Satti ◽

Lakshmi Leishangthem ◽

Alejandro Spiotta ◽

M Imran Chaudry

Keyword(s):

Visual Field ◽

Intracranial Hypertension ◽

Retrospective Analysis ◽

Idiopathic Intracranial Hypertension ◽

Venous Sinus ◽

Complication Rates ◽

Single Center ◽

Technical Success ◽

Dural Venous Sinus

Background Idiopathic intracranial hypertension (IIH) is a syndrome defined by elevated intracranial hypertension without radiographic evidence of a mass lesion in the brain. Dural venous sinus stenosis has been increasingly recognized as a treatable cause, and dural venous sinus stenting (DVSS) is increasingly performed. Methods A 5 year single-center retrospective analysis of consecutive patients undergoing DVSS for medically refractory IIH. Results There were 43 patients with a mean imaging follow-up of 6.5 months and a mean clinical follow-up period of 13.5 months. DVSS was performed as the first procedure for medically refractory IIH in 81.4% of patients, whereas 18.6% of patients included had previously had a surgical procedure (ventriculoperitoneal (VP) shunt or optic nerve sheath fenestration (ONSF)). Headache was present in all patients and after DVSS improved or remained stable in 69.2% and 30.8%, respectively. Visual acuity changes and visual field changes were present in 88.4% and 37.2% of patients, respectively. Visual field improved or remained unchanged in 92%, but worsened in 8% after stenting. There was a stent patency rate of 81.8%, with an 18.2% re-stenosis rate. Of the 43 procedures performed, there was a 100% technical success rate with zero major or minor complications. Conclusion Based on this single-center retrospective analysis, DVSS can be performed with high technical success and low complication rates. A majority of patients presented primarily with headache, and these patients had excellent symptom relief with DVSS alone. Patients presenting with visual symptoms had lower success rates, and this population, if stented, should be carefully followed for progression of symptoms.

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Venous sinus stenting as a treatment approach in patients with idiopathic intracranial hypertension and encephaloceles

Interventional Neuroradiology ◽

10.1177/1591019920956860 ◽

2020 ◽

pp. 159101992095686

Author(s):

Gerald T Drocton ◽

Alexander Copelan ◽

Laura Eisenmenger ◽

Javier E Villanueva-Meyer ◽

William P Dillon ◽

...

Keyword(s):

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Treatment Approach ◽

Filling Defect ◽

Brain Parenchyma ◽

Venous Sinus ◽

External Compression ◽

Dural Venous Sinus ◽

Adjacent Brain

Background Stenosis of a dural venous sinus is the most common cause of idiopathic intracranial hypertension (IIH) and can be classified as either intrinsic or extrinsic. Intrinsic stenoses are characterized by a focal filling defect within the sinus secondary to an enlarged arachnoid granulation or fibrous septa while extrinsic stenoses tend to be long and smooth-tapered and are most commonly secondary to external compression from the adjacent brain parenchyma. Brain herniations, or encephaloceles, into arachnoid granulations in dural venous sinuses have rarely been reported in the literature in patients with IIH. We propose that dural venous sinus stenting (VSS) may be a safe and effective treatment approach in patients with an encephalocele and IIH. Methods We retrospectively analyze three cases of patients with encephalocele who underwent VSS for treatment of medically refractory IIH at our institution. Results One patient underwent stenting ipsilateral and two patients underwent stenting contralateral to the side of their encephaloceles. No technical related issues or complications occurred during either of the three stenting procedures. Two out of the three patients had complete resolution in their IIH-related symptoms and normalization of cerebrospinal (CSF) pressures shortly after stenting. We await clinical follow-up in the third patient. Conclusions Our results suggest that VSS is a technically feasible and effective approach in treating patients with medically refractory IIH and encephaloceles.

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P-040 Major complications of dural venous sinus stenting for idiopathic intracranial hypertension: case series and management considerations

10.1136/neurintsurg-2021-snis.76 ◽

2021 ◽

Author(s):

R Townsend ◽

A Jost ◽

M Amans ◽

F Hui ◽

M Bender ◽

...

Keyword(s):

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Case Series ◽

Venous Sinus ◽

Major Complications ◽

Dural Venous Sinus

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

Interventional Neurology ◽

10.1159/000490578 ◽

2018 ◽

Vol 7 (6) ◽

pp. 490-500 ◽

Cited By ~ 14

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.

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Idiopathic Intracranial Hypertension: Contemporary Management and Endovascular Techniques

Seminars in Interventional Radiology ◽

10.1055/s-0040-1709172 ◽

2020 ◽

Vol 37 (02) ◽

pp. 175-181

Author(s):

David Case ◽

Joshua Seinfeld ◽

Christopher Roark ◽

David Kumpe

Keyword(s):

Intracranial Pressure ◽

Pressure Gradient ◽

Intracranial Hypertension ◽

Stent Placement ◽

Idiopathic Intracranial Hypertension ◽

Venous Sinus ◽

Endovascular Techniques ◽

Increased Intracranial Pressure ◽

Dural Venous Sinus

AbstractIdiopathic intracranial hypertension (IIH) is a disease process of abnormally increased intracranial pressure in the absence of a mass lesion. Medical management, optic nerve fenestration, and surgical shunting procedures have failed to produce consistently successful results. In an unknown percentage of cases, IIH is caused by dural venous sinus obstruction which can be cured by endovascular treatment with dural venous sinus stent placement. This helps prevent progressive vision loss and worsening papilledema caused by underlying increased intracranial pressure from venous outflow obstruction. Patients are required to have an established diagnosis of IIH, preferably made by a neuroophthalmologist, with clearly documented papilledema or at minimum visual disturbance along with lumbar puncture opening pressure greater than 25 cm H2O. Transverse to sigmoid sinus focal narrowing (intraluminal filling defect or extrinsic compression) must be seen during the venous phase of neuroangiography (NA) along with a pressure gradient of 10 mm Hg or greater across the focal narrowing during dural venous sinus pressure monitoring. A successful reduction is defined as a pressure gradient of less than 10 mm Hg after stent placement. Neuroophthalmologic follow-up occurs within 1 to 2 months to assess for changes in papilledema. If papilledema is unchanged or worsened, NA and hemodynamic evaluation is repeated for consideration of restenting. Appropriate patient selection criteria are required for IIH venous sinus stenting. The utilization of refined endovascular techniques along with postprocedure follow-up protocols can ultimately cure IIH for a select group of patients.

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Idiopathic intracranial hypertension: 120-day clinical, radiological, and manometric outcomes after stent insertion into the dural venous sinus

Journal of Neurosurgery ◽

10.3171/2017.4.jns162871 ◽

2018 ◽

Vol 129 (3) ◽

pp. 723-731 ◽

Cited By ~ 10

Author(s):

Hasan Asif ◽

Claudia L. Craven ◽

Almas H. Siddiqui ◽

Syed N. Shah ◽

Samir A. Matloob ◽

...

Keyword(s):

Clinical Outcome ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Case Series ◽

Outcome Data ◽

Venous Sinus ◽

Stent Insertion ◽

Complication Rates ◽

Considerable Uncertainty ◽

Dural Venous Sinus

OBJECTIVEIdiopathic intracranial hypertension (IIH) is commonly associated with venous sinus stenosis. In recent years, transvenous dural venous sinus stent (DVSS) insertion has emerged as a potential therapy for resistant cases. However, there remains considerable uncertainty over the safety and efficacy of this procedure, in particular the incidence of intraprocedural and delayed complications and in the longevity of sinus patency, pressure gradient obliteration, and therapeutic clinical outcome. The aim of this study was to determine clinical, radiological, and manometric outcomes at 3–4 months after DVSS in this treated IIH cohort.METHODSClinical, radiographic, and manometric data before and 3–4 months after DVSS were reviewed in this single-center case series. All venographic and manometric procedures were performed under local anesthesia with the patient supine.RESULTSForty-one patients underwent DVSS venography/manometry within 120 days. Sinus pressure reduction of between 11 and 15 mm Hg was achieved 3–4 months after DVSS compared with pre-stent baseline, regardless of whether the procedure was primary or secondary (after shunt surgery). Radiographic obliteration of anatomical stenosis correlating with reduction in pressure gradients was observed. The complication rate after DVSS was 4.9% and stent survival was 87.8% at 120 days. At least 20% of patients developed restenosis following DVSS and only 63.3% demonstrated an improvement or resolution of papilledema.CONCLUSIONSReduced venous sinus pressures were observed at 120 days after the procedure. DVSS showed lower complication rates than shunts, but the clinical outcome data were less convincing. To definitively compare the outcomes between DVSS and shunts in IIH, a randomized prospective study is needed.

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