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ScientificWorldJournal. 2015;2015:140408. doi: 10.1155/2015/140408. Epub 2015 Jun 4.

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

Author information

1
Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22908, USA.
2
Department of Radiology, University of Virginia, Charlottesville, VA 22908, USA.
3
Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22908, USA ; Department of Radiology, University of Virginia, Charlottesville, VA 22908, USA.
4
Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA 19107, USA.
5
Department of Neurological Surgery, University of Iowa, Iowa City, IA 52242, USA.
6
Department of Neurological Surgery, Tulane University, New Orleans, LA 70112, USA.

Abstract

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.

PMID:
26146651
PMCID:
PMC4471318
DOI:
10.1155/2015/140408
[Indexed for MEDLINE]
Free PMC Article

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