Transverse sinus stenting for idiopathic intracranial hypertension
Since 2005, transverse sinus stenting for idiopathic intracranial hypertension has grown in popularity, suggesting that Dural venous sinus stenosis should be viewed as a causative factor rather than a secondary phenomenon.
There remains considerable uncertainty over the safety and efficacy of this procedure, in particular the incidence of intraprocedural and delayed complications and in the longevity of sinus patency, pressure gradient obliteration, and therapeutic clinical outcome.
Although long term studies are needed in this field, the current reports indicate a favorable outcome for preventing vision loss and symptom control 1).
Venous stenting costs significantly less per 100 procedures than does CSF shunting, due largely to the high cost of treating shunt infections and the need for repeated shunt revisions 2).
In conjunction with temporary CSF diversion, represents a viable treatment option in the acute and appropriate setting 3).
In patients with documented evidence of venous sinus stenosis with a pressure gradient, venous sinus stenting should be the primary treatment of choice; however, some patients may be refractory to stenting and still require permanent CSF diversion, which can be complicated in these chronically anticoagulated patients. Patients with persistent papilledema post-stenting and highly elevated opening pressure pre-stenting should be followed closely as they are at greatest risk of requiring a shunt and failing stenting 4).
Dural venous sinus stenting for patients with IIH does not affect the immediate or long-term patency of the Vein of Labbe and is not associated with intracranial complications 5).
Case series
2017
The aim of a study was to determine clinical, radiological, and manometric outcomes at 3-4 months after DVSS in this treated IIH cohort.
Clinical, radiographic, and manometric data before and 3-4 months after DVSS were reviewed in this single-center case series. All venographic and manometric procedures were performed under local anesthesia with the patient supine.
Forty-one patients underwent DVSS venography/manometry within 120 days. Sinus pressure reduction of between 11 and 15 mm Hg was achieved 3-4 months after DVSS compared with pre-stent baseline, regardless of whether the procedure was primary or secondary (after shunt surgery). Radiographic obliteration of anatomical stenosis correlating with reduction in pressure gradients was observed. The complication rate after DVSS was 4.9% and stent survival was 87.8% at 120 days. At least 20% of patients developed restenosis following DVSS and only 63.3% demonstrated an improvement or resolution of papilledema.
Reduced venous sinus pressures were observed at 120 days after the procedure. DVSS showed lower complication rates than shunts, but the clinical outcome data were less convincing. To definitively compare the outcomes between DVSS and shunts in IIH, a randomized prospective study is needed 6).