title: Endovascular Treatment of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension: Complications, Neurological Outcomes, and Radiographic Results.
abstract: BACKGROUND
  Idiopathic intracranial hypertension (IIH) may result in a chronic debilitating disease. Dural venous sinus stenosis with a physiologic venous pressure gradient has been identified as a potential etiology in a number of IIH patients. Intracranial venous stenting has emerged as a potential treatment alternative.
  
  
  METHODS
  A systematic review was carried out to identify studies employing venous stenting for IIH.
  
  
  RESULTS
  From 2002 to 2014, 17 studies comprising 185 patients who underwent 221 stenting procedures were reported. Mean prestent pressure gradient was 20.1 mmHg (95% CI 19.4-20.7 mmHg) with a mean poststent gradient of 4.4 mmHg (95% CI 3.5-5.2 mmHg). Complications occurred in 10 patients (5.4%; 95% CI 4.7-5.4%) but were major in only 3 (1.6%). At a mean clinical follow-up of 22 months, clinical improvement was noted in 130 of 166 patients with headaches (78.3%; 95% CI 75.8-80.8%), 84 of 89 patients with papilledema (94.4%; 95% CI 92.1-96.6%), and 64 of 74 patients with visual symptoms (86.5%; 95% CI 83.0-89.9%). In-stent stenosis was noted in six patients (3.4%; 95% CI 2.5-4.3%) and stent-adjacent stenosis occurred in 19 patients (11.4%; 95% CI 10.4-12.4), resulting in restenting in 10 patients.
  
  
  CONCLUSIONS
  In IIH patients with venous sinus stenosis and a physiologic pressure gradient, venous stenting appears to be a safe and effective therapeutic option. Further studies are necessary to determine the long-term outcomes and the optimal management of medically refractory IIH.
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Tony
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Ding
authors.affiliation: Department of Radiology, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Durst
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22908, USA ; Department of Radiology, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: R Webster
authors.initials: RW
authors.lastname: Crowley
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: Department of Neurological Surgery, University of Iowa, Iowa City, IA 52242, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Hasan
authors.affiliation: Department of Neurological Surgery, Tulane University, New Orleans, LA 70112, USA.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.affiliation: Department of Neurological Surgery, University of Virginia, Charlottesville, VA 22908, USA ; Department of Radiology, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Liu
mesh_terms: D002561:Cerebrovascular Disorders / Q000150:complications* / Q000473:pathology*; D003251:Constriction, Pathologic; D003392:Cranial Sinuses / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011559:Pseudotumor Cerebri / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D011859:Radiography; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome