Unilateral transverse sinus stenting of patients with idiopathic intracranial hypertension.
OBJECTIVE
The pathophysiology of IIH remains unknown. TS stenoses have been observed in a high proportion of these patients. Stent placement to remove this potential obstruction to venous outflow has been proposed as a treatment option for patients with IIH refractory to medical treatment.


METHODS
The clinical presentation, treatment, and outcome of patients with refractory IIH evaluated for venous sinus stent placement at a tertiary care center was retrospectively reviewed.


RESULTS
Thirteen female patients with IIH were evaluated for sinovenous stent placement. Moderate sinus stenoses with normal intrasinus pressures were found in 3 patients and therefore stent placement was not performed. Ten patients had elevated intrasinus pressures (pressure gradient across stenosis, 11-50 mm Hg), which decreased following unilateral TS stent placement. Headaches improved or resolved in all stented patients. Papilledema resolved completely or almost completely in 8 patients and significantly improved in 2 patients. One patient developed optic atrophy. There were no major periprocedural complications.


CONCLUSIONS
In this small case series, restoring the patency of stenotic venous sinuses with a stent in patients with refractory IIH resulted in symptomatic improvement in all treated patients. The safety and efficacy of this procedure should be evaluated in a randomized controlled study to determine its role within the armamentarium of therapeutic options for patients with IIH.
Bussière
M
M
The Ottawa Hospital, Ontario, Canada. mbussiere@toh.on.ca
Falero
R
R
Nicolle
D
D
Proulx
A
A
Patel
V
V
Pelz
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002533:Cerebral Angiography; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging; D008365:Manometry; D008875:Middle Aged; D009460:Neurologic Examination; D009767:Obesity, Morbid / Q000150:complications; D009896:Optic Atrophy / Q000209:etiology; D011559:Pseudotumor Cerebri / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D054064:Transverse Sinuses; D016896:Treatment Outcome; D055815:Young Adult