scholarly journals Understanding the complex pathophysiology of idiopathic intracranial hypertension and the evolving role of venous sinus stenting: a comprehensive review of the literature

2018 ◽  
Vol 45 (1) ◽  
pp. E10 ◽  
Author(s):  
Nisha Giridharan ◽  
Smruti K. Patel ◽  
Amanda Ojugbeli ◽  
Aria Nouri ◽  
Peyman Shirani ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Clinical Symptoms ◽  
Treatment Strategies ◽  
Venous Sinus ◽  
Review Of The Literature ◽  
Optic Nerve Sheath Fenestration ◽  
Standard Management ◽  
Definition Of

Idiopathic intracranial hypertension (IIH) is a disease defined by elevated intracranial pressure without established etiology. Although there is now consensus on the definition of the disorder, its complex pathophysiology remains elusive. The most common clinical symptoms of IIH include headache and visual complaints. Many current theories regarding the etiology of IIH focus on increased secretion or decreased absorption of cerebrospinal fluid (CSF) and on cerebral venous outflow obstruction due to venous sinus stenosis. In addition, it has been postulated that obesity plays a role, given its prevalence in this population of patients. Several treatments, including optic nerve sheath fenestration, CSF diversion with ventriculoperitoneal or lumboperitoneal shunts, and more recently venous sinus stenting, have been described for medically refractory IIH. Despite the availability of these treatments, no guidelines or standard management algorithms exist for the treatment of this disorder. In this paper, the authors provide a review of the literature on IIH, its clinical presentation, pathophysiology, and evidence supporting treatment strategies, with a specific focus on the role of venous sinus stenting.

Clinical Review: The Surgical Treatment of Idiopathic Pseudotumour Cerebri (Idiopathic Intracranial Hypertension)

Cephalalgia ◽  
2008 ◽  
Vol 28 (12) ◽  
pp. 1361-1373 ◽  
Author(s):  
PW Brazis
Keyword(s):  
Surgical Treatment ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Randomized Study ◽  
Venous Sinus ◽  
Pseudotumour Cerebri ◽  
Advantages And Disadvantages ◽  
Optic Nerve Sheath Fenestration ◽  
Nerve Sheath

To review the literature on the surgical treatment of idiopathic pseudotumour cerebri (PTC) [idiopathic intracranial hypertension (IIH)]. When medical therapy fails or when visual dysfunction deteriorates, surgical therapies for PTC should be considered. The main procedures performed include lumboperitoneal shunt (LPS), ventriculoperitoneal shunt (VPS) and optic nerve sheath fenestration (ONSF). Recently, venous sinus stenting procedures have been performed on selected patients with PTC, especially those with venous sinus occlusive disease. The literature is summarized and appraised in the form of a narrative review. It is evident that ONSF, LPS, VPS and, in selected cases, venous sinus stenting may improve vision and prevent deterioration of vision in patients with PTC. All of the procedures have their advantages and disadvantages and may fail with time no matter what procedure is used. Various authorities have vehemently advocated one or the other of these procedures. Until a prospective, randomized study comparing ONSF with LPS or VPS for PTC is performed, and until the role of venous sinus obstruction as the aetiology of PTC is better defined, the question of which surgical procedure is best for the treatment of PTC remains unanswered.

scholarly journals Intracranial Venous Hypertension and Venous Sinus Stenting in the Modern Management of Idiopathic Intracranial Hypertension

Life ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 508
Author(s):  
Robert K. Townsend ◽  
Kyle M. Fargen
Keyword(s):  
Intracranial Hypertension ◽  
Young Women ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Hypertension ◽  
Venous Sinus ◽  
Venous Outflow ◽  
The Status ◽  
Insight Into ◽  
Symptom Recurrence

Idiopathic intracranial hypertension (IIH) is a debilitating condition that has traditionally been difficult to treat. In recent years, there has been increasing focus on the role of intracranial venous hypertension in the pathophysiology of IIH. Based on increased understanding of this pathophysiology, venous sinus stenting (VSS) has emerged as a safe and reliable treatment for a certain population of patients with IIH. Stratifying patients with IIH based on the status of their venous outflow can provide insight into which patients may enjoy reduction in their symptoms after VSS and provides information regarding why some patients may have symptom recurrence. The traditional view of IIH as a disease due to obesity in young women has been cast into doubt as the understanding of the role of intracranial venous hypertension has improved.

scholarly journals Exploring The Current Management Idiopathic Intracranial Hypertension, And Understanding The Role Of Dural Venous Sinus Stenting

Eye and Brain ◽  
2020 ◽  
Vol Volume 12 ◽  
pp. 1-13 ◽  
Author(s):  
Sam Gurney ◽  
Satheesh Ramalingam ◽  
Allan Thomas ◽  
Alexandra Sinclair ◽  
Susan Mollan
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Sinus ◽  
Current Management ◽  
Dural Venous Sinus

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.

Role of Resistivity Index Analysis in the Prediction of Hemodynamically Significant Venous Sinus Stenosis in Patient With Idiopathic Intracranial Hypertension

Neurosurgery ◽  
2019 ◽  
Vol 86 (5) ◽  
pp. 631-636 ◽  
Author(s):  
Mahmoud H Mohammaden ◽  
Muhammad Rizwan Husain ◽  
Denise Brunozzi ◽  
Ahmed E Hussein ◽  
Gursant Atwal ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Small Sample Size ◽  
Small Sample ◽  
Venous Sinus ◽  
Control Group ◽  
Multicenter Studies ◽  
Resistivity Index ◽  
Sinus Stenosis

Abstract BACKGROUND The resistivity index (RI) in cerebral venous sinus stenosis (VSS) has not been studied in patients with idiopathic intracranial hypertension (IIH). OBJECTIVE To evaluate the role of RI measured by quantitative magnetic resonance venogram (QMRV) as a noninvasive tool in the diagnosis of venous hypertension associated with VSS in IIH. METHODS Retrospective evaluation of 13 consecutive IIH patients who underwent venous sinus stenting at our institution between 2013 and 2018. Patients’ demographics, clinical presentation, cerebral mean venous sinus pressure (MVP), and RI both pre- and poststenting were recorded. The baseline RI was also compared to a control group. RESULTS Among 13 patients of IIH, 11 had unilateral VSS in dominant sinus, whereas 2 had bilateral VSS. RI was significantly higher in IIH patients compared to the control group in the superior sagittal (SSS) and transverse sinuses (TS) (0.21 vs 0.11, P = .01 and 0.22 vs 0.13, P = .03, respectively). The MVP (in mm Hg) decreased significantly after venous sinus stenting in the SSS (41.9 to 22.5, P < .001) and TS (39.4 to 19.5, P < .001), which was also associated with a significant reduction of the RI (0.22 vs 0.17, P < .01 in SSS and 0.23 vs 0.17, P = .03 in TS) poststenting. CONCLUSION RI calculated using QMRV can serve as a noninvasive tool to aid in the diagnosis of hemodynamically significant VSS. The study had a small sample size, and larger multicenter studies would be required to validate the results further.

Venous Sinus Pulsatility and the Potential Role of Dural Incompetence in Idiopathic Intracranial Hypertension

Neurosurgery ◽  
2012 ◽  
pp. 1
Author(s):  
Marc A. Lazzaro ◽  
Ziad Darkhabani ◽  
Bernd F. Remler ◽  
Sang H. Hong ◽  
Thomas J. Wolfe ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Potential Role ◽  
Venous Sinus
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