title: Visual and neurological outcomes following endovascular stenting for pseudotumor cerebri associated with transverse sinus stenosis.
abstract: BACKGROUND
  Pseudotumor cerebri (PTC) is characterized by raised intracranial pressure (ICP) without an identifiable mass, evidence of hydrocephalus, or abnormal cerebrospinal fluid content. In the past, most cases of PTC appeared to have no identifiable etiology, and thus, they were classified as "idiopathic intracranial hypertension" (IIH). Recently, however, a subset of patients with presumed IIH has been found to have evidence of cerebral dural sinus stenoses, particularly involving one or both transverse sinuses (TS). The belief that the stenoses are the cause, rather than an effect of the increased ICP, has led investigators to recommend stenting of the stenosed sinus for the treatment of the condition. We describe detailed visual and neurological outcomes after stenting for PTC associated with hemodynamically significant dural sinus stenosis.
  
  
  METHODS
  All patients with PTC had initial neurological, neuro-ophthalmological, and imaging assessments. Regardless of the findings, all were treated with medical therapy. If medical therapy failed and TS stenosis was detected on contrast-enhanced magnetic resonance or computed tomographic venography, catheter cerebral angiography with venous manometry was performed. If a mean pressure gradient (MPG) of 4 mm Hg or greater was present, unilateral transverse sinus stenting was performed.
  
  
  RESULTS
  Twelve patients with PTC and TS stenosis associated with an MPG of >4 mm Hg who failed medical therapy were identified. TS stenting significantly decreased the pressure gradient in all cases. Unilateral stenting was sufficient to reduce pressure gradients even when the stenosis was bilateral. At a mean follow-up of 16 months (range, 9-36 months), tinnitus had improved in all patients, and 10 of 12 patients had improvement in visual function. Seven patients had significant improvement in headaches.
  
  
  CONCLUSIONS
  In this small series of patients with PTC associated with TS stenosis, endovascular stent placement was generally effective in treating visual dysfunction and tinnitus, although not headaches. The optimum gradient and vascular characteristics amenable for selection of patients for stenting needs further research.
authors.affiliation: Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Radvany
authors.forename: David
authors.initials: D
authors.lastname: Solomon
authors.forename: Satnam
authors.initials: S
authors.lastname: Nijjar
authors.forename: Prem S
authors.initials: PS
authors.lastname: Subramanian
authors.forename: Neil R
authors.initials: NR
authors.lastname: Miller
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
authors.forename: Ari
authors.initials: A
authors.lastname: Blitz
authors.forename: Philippe
authors.initials: P
authors.lastname: Gailloud
authors.forename: Abhay
authors.initials: A
authors.lastname: Moghekar
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D003251:Constriction, Pathologic / Q000150:complications; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D011183:Postoperative Complications / Q000503:physiopathology*; D011559:Pseudotumor Cerebri / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D054064:Transverse Sinuses / Q000473:pathology*; D014786:Vision Disorders / Q000209:etiology*; D055815:Young Adult