Liu KC, Starke RM, Durst CR, et al. Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study. J Neurosurg. 2017;127(5):1126-1133. doi:10.3171/2016.8.JNS16879.
Although many cases of IIH are idiopathic, a number of patients have been found to have venous sinus stenosis as a potential underlying mechanism. During cerebral venography, manometry has demonstrated significant pressure gradients across the stenotic segments with elevated venous pressures most frequently proximally in the superior sagittal sinus. Currently, it is unclear whether this stenosis is the cause of IIH or the result of elevated ICP as a secondary disease process. Although stenting of the venous sinus stenosis has been shown in select cases to resolve the pressure gradient, the effect on ICP remains unclear. Additionally, the effects on visual and neurological outcomes remain incompletely defined.
The purpose of this pilot study was to assess the effects of venous sinus stenting on ICP in a small group of patients with IIH.
Ten patients for whom medical therapy had failed were prospectively followed. Ophthalmological examinations were assessed, and patients with venous sinus stenosis on MR angiography proceeded to catheter angiography, venography with assessment of pressure gradient, and ICP monitoring. Patients with elevated ICP measurements and an elevated pressure gradient across the stenosis were treated with stent placement.
All patients had elevated venous pressure (mean 39.5 mm Hg), an elevated gradient across the venous sinus stenosis (30.0 mm Hg), and elevated ICP (42.2 mm Hg). Following stent placement, all patients had resolution of the stenosis and gradient (1 mm Hg). The ICP values showed an immediate decrease (to a mean of 17.0 mm Hg), and further decreased overnight (to a mean of 8 mm Hg). All patients had subjective and objective improvement, and all but one improved during follow-up.
The novel findings of …