Efficacy of dural venous sinus stenting in treating idiopathic intracranial hypertension with acute vision loss

Zehri, Aqib; Lee, Katriel E.; Kartchner, Jeff; Arnel, Madison; Martin, Timothy J.; Wolfe, Stacey Quintero; Fargen, Kyle M

doi:10.1177/19714009211026923

Cited by 13 publications

(9 citation statements)

References 13 publications

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“…In addition, in looking only at the 3month post-VSS visit, it is possible that some patients had further improvement in pulsatile tinnitus later. Compared to prior studies reporting successful weaning of most of their patients off medication after stenting (16,27), there were 58 (67.4%) patients in our cohort still requiring IIH management medication post-stenting. This, too, is likely due to the short follow-up period used for our analyses (4.0 months in our cohort versus 15.12 and 19.70 months in the Touzéand Zehri studies).…”

Section: Discussioncontrasting

confidence: 79%

Improved Ophthalmic Outcomes Following Venous Sinus Stenting in Idiopathic Intracranial Hypertension

Oyemade

Brinjikji

et al. 2022

Front. Ophthalmol.

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BackgroundOphthalmic outcomes following venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH) are not well characterized.Materials and MethodsA retrospective chart review was conducted on 86 consecutive patients with IIH who underwent venous sinus stenting at Mayo Clinic, Rochester, Minnesota and Stanford Medical Center, Palo Alto, California between May 2015 and October 2021. Patients with raised intracranial pressure from a non-IIH etiology were excluded. Clinical symptoms and neuro-ophthalmological data, including best corrected visual acuity (BCVA), visual field mean deviation, papilledema, and optical coherence tomography (OCT) peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell inner plexiform layer (GC-IPL), were analyzed. Baseline measurements before VSS and 3 months or more postoperatively were compared.ResultsEighty-six subjects (82 female) were included in this study, with a median age of 33 (16–68) years and a median body mass index of 36.69 (22.30–62.00) kg/m2. 85/86 (98.8%) had attempted prior management with medication, and 12/86 (14%) had prior surgical management with optic nerve sheath fenestration, ventriculoperitoneal shunt, or bariatric surgery. Prior to VSS, 67/86 (77.9%) had papilledema, 85/86 (98.8%) had headaches, and 68/86 (79.1%) had pulsatile tinnitus. For patients with both pre- and post-VSS data available, the average papilledema grade was 1.76 (0–5) (n = 74) and the average OCT pRNFL was 186.34 (52.00–588.00) µm (n = 70), prior to VSS. A median of 4.0 (interquartile range 3.3–5.4) months after VSS, the average papilledema grade improved to 0.39 (0–2), p <0.001, and OCT pRNFL improved to 96.86 (47.00–168.00) µm, p <0.001. 28/86 (32.6%) patients no longer required medication for high intracranial pressure. 14/85 (16.5%) patients reported complete resolution of their headache and 55/71 (77.5%) reported improvement in headache quality. 40/68 (66.7%) reported complete resolution of pulsatile tinnitus. OCT GC-IPL, BCVA, and visual field mean deviation did not significantly change pre- vs post-VSS.ConclusionsOur large consecutive case series corroborates smaller prior studies in demonstrating the overall efficacy of VSS for patients with IIH. We found both ophthalmic improvements, as demonstrated by the significantly reduced papilledema and pRNFL, and overall clinical symptom improvement.

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Section: Discussioncontrasting

confidence: 79%

Improved Ophthalmic Outcomes Following Venous Sinus Stenting in Idiopathic Intracranial Hypertension

Oyemade

Brinjikji

et al. 2022

Front. Ophthalmol.

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“…Even this practice might change; there are now credible reports of satisfactory visual outcomes from TSS stenting as first treatment even for fulminant IIH. 59,60 In our view PTC patients with significant visual impairment need to be assessed, expeditiously, by a multi-disciplinary team in a tertiary facility that offers all possible interventional treatments for PTC: ONSF, TSS, temporary lumbar CSF drainage, 46 and occasionally, CSF shunting. 22,61 As in all retrospective case series of uncommon disorders, there are limitations due to selection bias, small numbers of patients and missing or limited data.…”

Section: Discussionmentioning

confidence: 99%

“…In the last 5 years of this study, in contrast to the first 5 years, we have tended to offer ONSF only to patients with acute or fulminant PTC as an emergency, sight‐saving measure. Even this practice might change; there are now credible reports of satisfactory visual outcomes from TSS stenting as first treatment even for fulminant IIH 59,60 . In our view PTC patients with significant visual impairment need to be assessed, expeditiously, by a multi‐disciplinary team in a tertiary facility that offers all possible interventional treatments for PTC: ONSF, TSS, temporary lumbar CSF drainage, 46 and occasionally, CSF shunting 22,61 …”

Section: Discussionmentioning

confidence: 99%

Optic nerve sheath fenestration for treating papilloedema in the era of cerebral venous sinus stenting

McCluskey

Lam

Ang

et al. 2023

Clinical Exper Ophthalmology

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Background Pseudotumour cerebri (PTC) is the syndrome of intracranial hypertension without intracranial mass or hydrocephalus and is the commonest cause of papilloedema seen in many eye clinics. In the last 10 years, we have increasingly used TSS in patients whose papilloedema was not well controlled with medical treatment and have done fewer ONSFs. Here, we review our experience at Royal Prince Alfred Hospital Sydney with ONSF in 35 patients over the period 2002–2021. Methods Retrospective case series of 35 patients, 30 of whom had primary PTC [i.e., idiopathic intracranial hypertension (IIH)] and 5 with secondary PTC. Results Eighteen patients had bilateral ONSF and 17 patients unilateral ONSF, in each case of the worse eye. Thirteen patients then underwent transverse sinus stenting (TSS), in each case following ONSF. The primary outcome measures were visual acuity (VA) and mean deviation (MD) on visual field (VF) testing. MD improved by 5 dB or more in 34 of 70 total eyes (48.6%); VA improved by 0.2 logMAR (two lines on Snellen chart) or more in 21 eyes (30%), and by both in 15 eyes (21.4%). Final MD was −10 dB or better in 38 eyes (54.3%); final VA was 0.3 (6/12) or better in 54 eyes (77.1%), and both in 39 eyes (55.7%). Conclusions The results confirm that ONSF can relieve papilloedoema in both eyes and improve both VF and VA, even in cases of fulminant PTC with severe acute visual impairment.

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“…2 Several studies have shown promising results with venous stenting, with improvements in symptoms and visual function and significantly reduced intracranial pressure. 18,20,27,31,56 Compared with other treatment modalities, venous stenting may offer several advantages, including a lower risk of complications and a more durable solution. However, more studies are needed to compare the long-term outcomes and cost-effectiveness of venous stenting vs other treatment options for IIH.…”

Section: Discussionmentioning

confidence: 99%

Transverse Venous Stenting for the Treatment of Idiopathic Intracranial Hypertension With a Pressure Gradient of 70 mm Hg: A Technical Note and Systematic Review

Ghanem,

El Naamani,

Rawad

et al. 2023

Operative Neurosurgery

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BACKGROUND AND IMPORTANCE: Venous sinus stenosis is believed to play a role in the pathogenesis of idiopathic intracranial hypertension (IIH). Venous stenting has emerged as a promising treatment option for patients with IIH because of venous sinus stenosis refractory to medical management or unsuitable for shunt placement. In this technical note, we present a case of IIH with the highest recorded pressure gradient to date. CLINICAL PRESENTATION: This technical note presents the successful use of intracranial venous stenting in a patient with IIH because of severe venous sinus stenosis, leading to significant improvement in vision and reduction in intracranial pressure. A meticulous review of the literature revealed that our patient exhibited the highest recorded pressure gradient (70 cm of H2O). This remarkable finding underscores the potential effectiveness of venous stenting as a viable treatment approach. The procedure involved the placement of a Zilver stent (Cook Medical) and balloon angioplasty after stenting of the right transverse sinus stenosis, resulting in a substantial decrease in pressure gradient. Following the procedure, another venous manometry showed no more gradient with a uniform pressure in the whole venous system at 18 cm of H2O. CONCLUSION: To our knowledge, this case presents the highest pressure gradient reported in the literature and contributes to the growing evidence supporting venous stenting in patients with IIH and venous sinus stenosis.

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Efficacy of dural venous sinus stenting in treating idiopathic intracranial hypertension with acute vision loss

Cited by 13 publications

References 13 publications

Improved Ophthalmic Outcomes Following Venous Sinus Stenting in Idiopathic Intracranial Hypertension

Improved Ophthalmic Outcomes Following Venous Sinus Stenting in Idiopathic Intracranial Hypertension

Optic nerve sheath fenestration for treating papilloedema in the era of cerebral venous sinus stenting

Transverse Venous Stenting for the Treatment of Idiopathic Intracranial Hypertension With a Pressure Gradient of 70 mm Hg: A Technical Note and Systematic Review

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