title: Venous sinus stenting is a valuable treatment for fulminant idiopathic intracranial hypertension.
abstract: Over the past 10 years, transverse sinus stenting has grown in popularity as a treatment for idiopathic intracranial hypertension. Although promising results have been demonstrated in several reported series, the vast majority of patients in these series have been treated on an elective basis rather than in the setting of fulminant disease with acute visual deterioration. We identified four patients who presented with severe acute vision loss between 2008 and 2012 who were treated with urgent transverse sinus stenting with temporary cerebrospinal fluid (CSF) diversion with lumbar puncture or lumbar drain as a bridge to therapy. All patients presented with headache, and this was stable or had improved at last follow-up. Three patients had improvement in some or all visual parameters following stenting, whereas one patient who presented with severe acute vision loss and optic disc pallor progressed to blindness despite successful stenting. We hypothesize that she presented too late in the course of the disease for improvement to occur. Although the management of fulminant idiopathic intracranial hypertension remains challenging, we believe that transverse sinus stenting, in conjunction with temporary CSF diversion, represents a viable treatment option in the acute and appropriate setting.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, Zayed Tower, 1800 Orleans Street, Baltimore, MD 21287, USA. Electronic address: belder4@jhmi.edu.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, Zayed Tower, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, Zayed Tower, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Kosztowski
authors.affiliation: Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Radvany
authors.affiliation: Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gailloud
authors.affiliation: Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Abhay
authors.initials: A
authors.lastname: Moghekar
authors.affiliation: Department of Ophthalmology, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Prem S
authors.initials: PS
authors.lastname: Subramanian
authors.affiliation: Department of Ophthalmology, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Miller
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, Zayed Tower, 1800 Orleans Street, Baltimore, MD 21287, USA.
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
mesh_terms: D000328:Adult; D001766:Blindness / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D020227:Lateral Sinus Thrombosis / Q000150:complications / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D015594:Optic Disk Drusen / Q000209:etiology; D011559:Pseudotumor Cerebri / Q000150:complications / Q000601:surgery*; D015607:Stents; D014012:Tinnitus / Q000209:etiology; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology; D014787:Vision Tests; D014792:Visual Acuity; D055815:Young Adult
keywords: Hydrocephalus; Idiopathic intracranial hypertension; Pseudotumor cerebri; Transverse sinus stenting; Vision loss