[Endovascular treatment of benign intracranial hypertension by stent placement in the transverse sinus. Therapeutic and pathophysiological considerations illustrated by a case report].
We report a case of benign intracranial hypertension in a 31-year-old man treated by endovascular stent placement in the right transverse sinus. The patient presented with a typical benign intracranial hypertension syndrome. Ophthalmologic findings showed bilateral papilledema with a 7/10 loss visual acuity loss in the right eye and 2/10 in the left eye. At lumbar puncture, cerebrospinal fluid (CSF) pressure was 40 mmHg. Magnetic resonance imaging (MRI) showed slit ventricles and dilatation of optic nerve sheaths. optiques. After failure of medical treatment, the patient was referred to our neurosurgical department for therapeutic decision. Direct retrograde cerebral venography showed predominant cerebral venous drainage via the right transverse sinus which exhibited stenosis in its proximal third. Mamometry revealed a 25 mmHg pressure gradient across the point of stenosis. Due to possible venogenic benign intracranial hypertension, endovascular stent placement was proposed and accepted by the patient. At 3 months follow-up, the patient was symptoms free, papilledema had disappeared and visual acuity was 10/10 on both eyes. CSF pressure on lumbar puncture was 11 mmHg. The pathophysiological aspects and therapeutic management of this pathology illustrated by this are discussed along with a careful and exhaustive review of the literature.
Métellus
Ph
P
Département de Neurochirurgie, Hôpital de La Timone, 264, rue Saint-Pierre, 13385 Marseille. philippe.metellus@mail.ap-hm.fr
Levrier
O
O
Fuentes
S
S
Adetchessi
T
T
Dufour
H
H
Donnet
A
A
Grisoli
F
F
D000328:Adult; D000800:Angioplasty, Balloon / Q000295:instrumentation; D002561:Cerebrovascular Disorders / Q000503:physiopathology / Q000628:therapy; D003251:Constriction, Pathologic / Q000503:physiopathology / Q000628:therapy; D003392:Cranial Sinuses / Q000503:physiopathology*; D005500:Follow-Up Studies; D006801:Humans; D019586:Intracranial Hypertension / Q000503:physiopathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D013129:Spinal Puncture; D015607:Stents; D013577:Syndrome