title: Idiopathic Intracranial Hypertension. A Systematic Analysis of Transverse Sinus Stenting.
abstract: BACKGROUND
  Idiopathic intracranial hypertension (IIH) is a disorder characterized by signs and symptoms of increased intracranial pressure without structural cause seen on conventional imaging. Hallmark treatment after failed medical management, has been CSF shunting or optic nerve fenestration with the goal of treatment being preservation of vision. Recently, there have been multiple case reports and case series on dural sinus stenting for this disorder.
  
  
  OBJECTIVE
  We aim to review all published cases and case series of dural sinus stenting for IIH, with analysis of patient presenting symptoms, objective findings (CSF pressures, papilledema, pressure gradients across dural sinuses), follow-up of objective findings, and complications.
  
  
  METHODS
  A Medline search was performed to identify studies meeting pre-specified criteria of a case report or case series of patients treated with dural sinus stent placement for IIH. The manuscripts were reviewed and data was extracted.
  
  
  RESULTS
  A total of 22 studies were identified, of which 19 studies representing 207 patients met criteria and were included in the analysis. Only 3 major complications related to procedure were identified. Headaches resolved or improved in 81% of patients. Papilledema improved the (172/189) 90%. Sinus pressure decreased from an average of 30.3 to 15 mm Hg. Sinus pressure gradient decreased from 18.5 (n=185) to 3.2 mm Hg (n=172). Stenting had an overall symptom improvement rate of 87%.
  
  
  CONCLUSIONS
  Although all published case reports and case series are nonrandomized, the low complication and high symptom improvement rate make dural sinus stenting for IIH a potential alternative surgical treatment. Standardized patient selection and randomization trials or registry are warranted.
authors.affiliation: Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Teleb
authors.affiliation: Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Cziep
authors.affiliation: Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI ; Department of Neurosurgery, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI ; Department of Radiology, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Lazzaro
authors.affiliation: Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI.
authors.forename: Ayman
authors.initials: A
authors.lastname: Gheith
authors.affiliation: Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI.
authors.forename: Kaiz
authors.initials: K
authors.lastname: Asif
authors.affiliation: Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI ; Department of Ophthalmology, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI.
authors.forename: Bernd
authors.initials: B
authors.lastname: Remler
authors.affiliation: Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI ; Department of Neurosurgery, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI ; Department of Radiology, Medical College of Wisconsin/Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI.
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
keywords: Idiopathic intracranial hypertension; Pseudotumor Cerebri; Venous stenosis; angiography; sinus stenting; stenosis; stenting