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J Clin Neurosci. 2015 Apr;22(4):685-9. doi: 10.1016/j.jocn.2014.10.012. Epub 2015 Jan 8.

Venous sinus stenting is a valuable treatment for fulminant idiopathic intracranial hypertension.

Author information

1
Department of Neurosurgery, The Johns Hopkins Hospital, Zayed Tower, 1800 Orleans Street, Baltimore, MD 21287, USA. Electronic address: belder4@jhmi.edu.
2
Department of Neurosurgery, The Johns Hopkins Hospital, Zayed Tower, 1800 Orleans Street, Baltimore, MD 21287, USA.
3
Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA.
4
Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA.
5
Department of Ophthalmology, The Johns Hopkins Hospital, Baltimore, MD, USA.

Abstract

Over the past 10 years, transverse sinus stenting has grown in popularity as a treatment for idiopathic intracranial hypertension. Although promising results have been demonstrated in several reported series, the vast majority of patients in these series have been treated on an elective basis rather than in the setting of fulminant disease with acute visual deterioration. We identified four patients who presented with severe acute vision loss between 2008 and 2012 who were treated with urgent transverse sinus stenting with temporary cerebrospinal fluid (CSF) diversion with lumbar puncture or lumbar drain as a bridge to therapy. All patients presented with headache, and this was stable or had improved at last follow-up. Three patients had improvement in some or all visual parameters following stenting, whereas one patient who presented with severe acute vision loss and optic disc pallor progressed to blindness despite successful stenting. We hypothesize that she presented too late in the course of the disease for improvement to occur. Although the management of fulminant idiopathic intracranial hypertension remains challenging, we believe that transverse sinus stenting, in conjunction with temporary CSF diversion, represents a viable treatment option in the acute and appropriate setting.

KEYWORDS:

Hydrocephalus; Idiopathic intracranial hypertension; Pseudotumor cerebri; Transverse sinus stenting; Vision loss

PMID:
25579238
DOI:
10.1016/j.jocn.2014.10.012
[Indexed for MEDLINE]

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