Emergent cerebral venous stenting: A valid treatment option for fulminant idiopathic intracranial hypertension

Horev, Anat; Ben-Arie, Gal; Walter, Eyal; Tsumi, Erez; Regev, Tamir; Aloni, Eyal; Biederko, Ron; Zlotnik, Yair; Lebowitz, Zachary; Shelef, Ilan; Honig, Asaf

doi:10.1016/j.jns.2023.120761

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…These findings may suggest a more fulminant nature of the disease in non-obese patients. This observation has been reported in fulminant IIH patients in the past [ 14 ]. Moreover, non-obese neuroimaging features included higher rates of scleral flattening and optic nerve dural ectasia.…”

Section: Discussionsupporting

confidence: 82%

“…Recent studies describe unique subgroups among the IIH patient population: pediatric patients, adults above forty years old, men, and fulminant IIH patients. It is worth noting that these subgroups exhibit a significantly lower prevalence of obesity [ 10 , 11 , 12 , 13 , 14 ]. We assume that significant gaps remain in our understanding of these unconventional IIH groups.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Radiological Characteristics of Non-Obese Female Patients with Idiopathic Intracranial Hypertension

Horev,

Ben-Arie,

Zlotnik

et al. 2024

JCM

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While the typical patient with idiopathic intracranial hypertension (IIH) is an obese female of childbearing age, there are unique patient populations, such as non-obese females, that have not been well studied. Characterizing this subpopulation may increase awareness our of it, which may prevent underdiagnosis and improve our understanding of IIH’s underlying pathophysiology. We retrospectively reviewed electronic medical records and compared the clinical and radiological characteristics of non-obese (BMI < 30) and obese (BMI > 30) female patients with IIH. Two hundred and forty-six patients (age 32.3 ± 10) met our inclusion criteria. The non-obese patients (n = 59, 24%) were significantly younger than the obese patients (29.4 ± 9.9 vs. 33.2 ± 10.2, p = 0.004) and had higher rates of severe papilledema (Friesen 4–5; 25.4% vs. 11.8%, p = 0.019), scleral flattening (62.7% vs. 36.9%, p = 0.008), and optic nerve dural ectasia (78.0% vs. 55.6%, p = 0.044). Non-obese patients also had a tendency to have a higher lumbar puncture opening pressure (368 ± 92.7 vs. 344 ± 76.4, p = 0.062). Non-obese patients were three times more likely to present with a combination of scleral flattening and optic nerve dural ectasia (OR = 3.00, CI: 1.57–5.72, χ2 = 11.63, α < 0.001). Overall, non-obese females with IIH were found to have a more fulminant presentation, typified by higher rates of severe papilledema and radiological findings typical for IIH.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Characteristics of Non-Obese Female Patients with Idiopathic Intracranial Hypertension

Horev,

Ben-Arie,

Zlotnik

et al. 2024

JCM

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“…14,21 For VFMD, these values are 75-100%, 0%, and 0-25%, demonstrating less heterogeneity than VA outcomes. 14,16,21 Systematic reviews and meta-analyses have found the rate of VA improvement post-TSS to range from 69% to 78%; 9–11 one meta-analysis combined VA, VFMD, and subjective visual complaints into a composite outcome and found a postoperative improvement rate of 74%. 12 However, none of these systematic reviews provided a quantitative definition of VA change.…”

Section: Discussionmentioning

confidence: 99%

Visual and pharmacotherapy outcomes after transverse sinus stenting for idiopathic intracranial hypertension

Handzic,

Xie,

Hendriks

et al. 2023

Preprint

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Background Transverse sinus stenting (TSS) is an increasingly commonly used treatment for patients with idiopathic intracranial hypertension (IIH). However, detailed neuro-ophthalmic evidence on visual and pharmacotherapy outcomes after TSS is scarce and heterogeneous. This study aimed to describe the visual outcomes of patients undergoing TSS for IIH and to ascertain the proportion of patients who could be weaned off intracranial pressure (ICP)-lowering medication after this procedure. Methods A retrospective chart review of all patients with IIH from two tertiary academic neuro-ophthalmology practices who underwent TSS between 2016 and 2022 was performed. Indications for stenting included failure of pharmacotherapy, intolerance of pharmacotherapy, and acute vision loss from severe papilledema. Data on demographics, symptoms, visual function, and TSS were collected. The paired Wilcoxon rank sum test was used to compare changes in visual acuity (VA) and visual field mean deviation (VFMD) between the baseline and most recent visits. Results Of 435 patients with IIH, 15 (13 women) met inclusion criteria. After TSS, ICP-lowering pharmacotherapy was discontinued in 10 patients and decreased in 4; one patient was not on ICP-lowering medication before TSS. All patients experienced resolution or improvement of symptoms (10 resolution, 4 improved, 1 asymptomatic before TSS) and papilledema (11 resolution, 4 improved) after stenting. Papilledema resolution was confirmed with optical coherence tomography-measured peripapillary nerve fibre layer thickness (median decrease 147 um, interquartile range 41.8 - 242.8, p<0.001). Change in VA between the baseline and most recent visit was not significant, but VFMD improved significantly after stenting (median increase 3.0, IQR 2.0 - 4.2, p<0.001). No patient developed transverse sinus restenosis nor in-stent thrombosis postoperatively across a median venogram follow-up of 20.8 weeks (11.3 - 49.8) and no patient required subsequent surgical intervention for IIH. Conclusion In this cohort of patients with IIH and fulminant presentation, medication resistance, or medication intolerance, TSS was an effective and safe treatment modality. Most patients were able to stop ICP-lowering medications while demonstrating striking improvement in symptomatology and visual function.

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Emergent cerebral venous stenting: A valid treatment option for fulminant idiopathic intracranial hypertension

Cited by 5 publications

References 22 publications

Clinical and Radiological Characteristics of Non-Obese Female Patients with Idiopathic Intracranial Hypertension

Clinical and Radiological Characteristics of Non-Obese Female Patients with Idiopathic Intracranial Hypertension

Visual and pharmacotherapy outcomes after transverse sinus stenting for idiopathic intracranial hypertension

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