title: Meta-Analysis of CSF Diversion Procedures and Dural Venous Sinus Stenting in the Setting of Medically Refractory Idiopathic Intracranial Hypertension.
abstract: OBJECTIVE
  In medically refractory idiopathic intracranial hypertension, optic nerve sheath fenestration or CSF shunting is considered the next line of management. Venous sinus stenosis has been increasingly recognized as a treatable cause of elevated intracranial pressure in a subset of patients. In this article, we present the results of the largest meta-analysis of optic nerve sheath fenestration, CSF shunting, and dural venous sinus stenting. This is the only article that compares these procedures, to our knowledge.
  
  
  METHODS
  We performed a PubMed search of all peer-reviewed articles from 1988 to 2014 for patients who underwent a procedure for medically refractory idiopathic intracranial hypertension.
  
  
  RESULTS
  Optic nerve sheath fenestration analysis included 712 patients. Postprocedure, there was improvement of vision in 59%, headache in 44%, and papilledema in 80%; 14.8% of patients required a repeat procedure with major and minor complication rates of 1.5% and 16.4%, respectively. The CSF diversion procedure analysis included 435 patients. Postprocedure, there was improvement of vision in 54%, headache in 80%, and papilledema in 70%; 43% of patients required at least 1 additional surgery. The major and minor complication rates were 7.6% and 32.9%, respectively. The dural venous sinus stenting analysis included 136 patients. After intervention, there was improvement of vision in 78%, headache in 83%, and papilledema in 97% of patients. The major and minor complication rates were 2.9% and 4.4%, respectively. Fourteen additional procedures were performed with a repeat procedure rate of 10.3%. Three patients had contralateral stent placement, while 8 had ipsilateral stent placement within or adjacent to the original stent. Only 3 patients required conversion to CSF diversion or 2.2% of patients with stents.
  
  
  CONCLUSIONS
  Patients with medically refractory idiopathic intracranial hypertension have traditionally undergone a CSF diversion procedure as the first intervention. This paradigm may need to be re-examined, given the high technical and clinical success and low complication rates with dural venous sinus stenting.
authors.affiliation: From the Department of Neurointerventional Surgery (S.R.S., L.L.), Christiana Care Health Center, Wilmington, Delaware ssatti@christianacare.org.
authors.forename: S R
authors.initials: SR
authors.lastname: Satti
authors.affiliation: From the Department of Neurointerventional Surgery (S.R.S., L.L.), Christiana Care Health Center, Wilmington, Delaware.
authors.forename: L
authors.initials: L
authors.lastname: Leishangthem
authors.affiliation: Department of Neuroradiology (M.I.C.), Medical University of South Carolina, Charleston, South Carolina.
authors.forename: M I
authors.initials: MI
authors.lastname: Chaudry
mesh_terms: D002557:Cerebrospinal Fluid Shunts / Q000379:methods*; D003251:Constriction, Pathologic / Q000601:surgery; D003392:Cranial Sinuses / Q000601:surgery*; D006801:Humans; D009900:Optic Nerve / Q000601:surgery; D011559:Pseudotumor Cerebri / Q000175:diagnosis / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome