Idiopathic intracranial hypertension with stenosis of a solitary occipital venous sinus treated with stenting

Balushi, Ali Al; Oliveira, Cristiano Aguiar de; Patsalides, Athos

doi:10.1177/1591019920949094

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…Following an extensive systematic review, our patient's gradient pressure surpasses all others documented in the literature (Table). 3-52 According to our systematic review, the highest recorded gradient pressure was 67 mm Hg reported by Tschoe et al 36 who highlighted the impact of changes in mean arterial pressure and end-tidal carbon dioxide on venous sinus pressures in patients with IIH undergoing venous sinus stenting. Moreover, Ahmed et al reviewed clinical, venographic, and intracranial pressure data before and after stent placement in transverse sinus stenosis in 52 patients with IIH; the highest pressure gradient they reported was 41 mm Hg.…”

Section: Discussionmentioning

confidence: 82%

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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Section: Discussionmentioning

confidence: 82%

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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“…9,20 Two recent case reports of MS stenosis associated with IIH described clinical improvement after stenting of the sinus, supporting LS and MS stenosis being similar pathologies. 13,14 Finally, 2 patients were treated for LS and MS stenoses during the same procedure, interpreted as a limitation of our results (because the responsibility of the MS stenosis is uncertain). However, performing 2 different interventions to test which stenosis was responsible for the PT was, in our opinion, not feasible outside a prospective clinical trial.…”

Section: Discussionmentioning

confidence: 95%

“…Preceding reports have described MS stenosis as a cause for venous PT 12 or IIH. 13,14 However, Li et al 12 referred to it as a stenosis of the vein of the hypoglossal canal. We believe it is an inaccurate name because the sinus is reaching the jugular bulb without crossing the hypoglossal canal.…”

Section: Discussionmentioning

confidence: 99%

Pulsatile Tinnitus Due to Stenosis of the Marginal Sinus: Diagnosis and Endovascular Treatment

Cortese

Eliezer

Guédon

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Venous pulsatile tinnitus is a disabling condition mainly caused by a stenosis of the lateral sinus. Here, we aimed to report a novel cause of venous pulsatile tinnitus, stenosis of the marginal sinus. MATERIALS AND METHODS:We retrospectively analyzed patients with isolated venous pulsatile tinnitus for which the suspected cause was a stenosis of the marginal sinus, treated or not, between January 2017 and December 2020. Patient charts and imaging were systematically reviewed. All patients underwent noncontrast temporal bone CT and MR imaging.RESULTS: Eight patients (7 women; median age, 36 years) were included. Six patients (75%) were overweight, and 1 patient had idiopathic intracranial hypertension. All patients presented with a typical venous pulsatile tinnitus. The stenosis of the marginal sinus was detected using oblique reconstructions on postcontrast 3D MR imaging. There was no other pathologic finding except ipsilateral stenosis of the lateral sinus in 3 patients. Four patients underwent endovascular therapy with placement of a stent in the marginal sinus, leading to complete resolution of the pulsatile tinnitus for all of them. No complication occurred. Of note, the symptoms of intracranial hypertension also regressed after stent placement in that patient. CONCLUSIONS:Marginal sinus stenosis is a novel cause of venous pulsatile tinnitus, which can be easily detected on MR imaging. Marginal sinus stent placement is safe and efficient. We hypothesized that the marginal sinus stenosis pathophysiology is similar to that of lateral sinus stenosis, which is a common and well-known cause of venous pulsatile tinnitus, explaining the similar clinical presentation and endovascular management.ABBREVIATIONS: IIH ¼ idiopathic intracranial hypertension; LS ¼ lateral sinus; MS ¼ marginal sinus; OS ¼ occipital sinus; PT ¼ pulsatile tinnitus; SSS ¼ superior sagittal sinus; VAS ¼ visual analog scale P ulsatile tinnitus (PT) is an uncommon-but-disabling symptom, which has numerous causes, both vascular and nonvascular. 1 Venous etiologies of PT are suspected when the tinnitus disappears by compressing the ipsilateral internal jugular vein. Venous etiologies of PT are increasingly reported and are related to venous abnormalities like lateral sinus (LS) stenosis, 2 sigmoid sinus diverticulum, 3,4 dehiscence, 5 or a mastoid emissary vein. 6 It is paramount to recognize such anomalies because they are often manageable by endovascular treatment. 2,3,6 Here, we report the clinical and radiographic features as well as the therapeutic management of patients with PT caused by a stenosis of the marginal sinus (MS).

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“…In such cases, when IIH supervenes, stenosis along this pathway may occur. Al Balushi et al 103 published a case of IIH in which a persistent enlarged occipital sinus demonstrated severe distal stenosis, with hypoplastic right and aplastic left transverse sinuses. Stenting of the stenotic segment resulted in the resolution of papilledema and normalization of ICP.…”

Section: Stenosis Within Variant Venous Outflowmentioning

confidence: 99%

Idiopathic Intracranial Venous Hypertension: Toward a Better Understanding of Venous Stenosis and the Role of Stenting in Idiopathic Intracranial Hypertension

Dinkin¹,

Patsalides²

2023

Journal of Neuro-Ophthalmology

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Background: Venous sinus stenosis, typically at the junction of the transverse and sigmoid sinus, is increasingly recognized as a contributor to the pathophysiology of idiopathic intracranial hypertension (IIH), whether it be the intrinsic type that does not reverse with normalization of intracranial pressure or the extrinsic type, which does. Efforts to treat the stenosis and reduce the associated transstenotic gradient through placement of a stent at the site of stenosis have been studied over the past 2 decades, primarily through retrospective studies, with variable emphasis on formal visual testing and direct assessment of poststent opening pressure. Most studies have presented evidence for utilization of stenting as an alternative to cerebrospinal fluid shunting or optic nerve sheath fenestration in patients with IIH who harbor the stenosis and are refractory to or intolerant of intracranial pressure–lowering medications, but an assessment of the current data is needed to better understand the role of stenting for this patient population. Evidence Acquisition: A search in PubMed was made for “IIH,” “papilledema,” and “venous stenting.” Data pre and post stenting, including symptoms attributable to IIH, intracranial pressure, papilledema, retinal nerve fiber layer thickening on optical coherence tomography, and visual field assessment (mean deviation), were collected. Need for retreatment and complications were assessed among all studies. Studies using stenting for special circumstances, such as cerebrospinal leaks or for stenosis along anomalous vessels, were reviewed. Results: In total, 49 studies (45 retrospective and 4 prospective) and 18 case reports (with 3 or less patients) were found and included in the analysis, for a total of 1,626 patients. In 250 patients in whom poststent intracranial pressure was measured, the mean value was 19.7 cm H2O, reduced from a mean of 33 cm H2O. Transient visual obscurations resolved in 79.6% of 201 patients who complained of it, pulsatile tinnitus resolved in 84.7% of 515, diplopia resolved in 93% of 86 patients, and nonspecific visual symptoms such as “blurry vision” improved in 76.2% of 537 patients. Headaches resolved in 36% and improved in a further 40.7% of 1,105 patients in whom they were documented before stenting. Of 1,116 with papilledema, 40.8% demonstrated resolution and 38.2% improvement. The mean retinal nerve fiber layer thickness improved from 170.2 µm to 89.2 µm among 402 eyes in which optical coherence tomography was used to measure it. Among 135 eyes in which formal visual fields were performed pre and post stenting, the prestent average mean deviation of −7.35 dB improved to −4.72 dB after stenting. Complications associated with stenting included in-stent stenosis or thrombosis, subdural hematoma, intracerebral hematoma, cerebral edema, stent migration, and death. A recurrence of symptoms requiring a follow-up surgical intervention occurred in 9%. Conclusions: A growing body of evidence supports the use of venous sinus stenting as a viable option for medically refractory IIH, especially when papilledema threatens visual function. Complication and failure rates seem to be similar to alternative surgical approaches, although serious neurological sequalae can rarely occur. Emerging studies evaluating stent type, including novel stents designed for use in the venous system, may help improve ease of the procedure and long-term success rates. Prospective head-to-head studies are needed to better understand the performance of stenting compared with other interventions.

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Idiopathic intracranial hypertension with stenosis of a solitary occipital venous sinus treated with stenting

Cited by 6 publications

References 13 publications

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

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

Pulsatile Tinnitus Due to Stenosis of the Marginal Sinus: Diagnosis and Endovascular Treatment

Idiopathic Intracranial Venous Hypertension: Toward a Better Understanding of Venous Stenosis and the Role of Stenting in Idiopathic Intracranial Hypertension

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