Intracranial Venous Sinus Stenting for Benign Intracranial Hypertension: Clinical Indications, Technique, and Preliminary Results

Meta-Analysis of CSF Diversion Procedures and Dural Venous Sinus Stenting in the Setting of Medically Refractory Idiopathic Intracranial Hypertension

“…A second is decreased CSF absorption by the arachnoid granulations, which are pressure-sensitive. 3,12,16,17,20 Stent placement has been hypothesized to lower intracranial pressure by removing a Starling-like resistor, thereby removing the positive feedback loop. 19 With noninvasive imaging, such as contrast-enhanced MRV, 3 patterns of dural venous sinus stenting may be amenable to sinus stent placement:…”

“…Stents included the following: Bridge X3 stent (Medtronic, Santa Rosa, California), 16 S.M.A.R.T. stent (Cordis, Fremont, California), 16 Complete SE stent (Medtronic), 19 Zilver biliary stent (Cook Medical, Bloomington, Indiana), 6,20,21 (Worthington Biochemical, Lakewood, New Jersey), Precise self-expanding stent (Cordis), 21 or Acculink stent (Guidant, St. Paul, Minnesota). 21 After the intervention, headache improved in 83% (101/121 cases) and papilledema improved in 97% of patients (104/108 cases).…”

“…Venous sinus stent placement was first described by Higgins et al 15 During the past 20 years, an increasing number of case reports and larger case series have described dural venous sinus stent placement, and reported high rates of technical success and favorable clinical outcomes. 6,7,[16][17][18][19][20][21] In this article, we present the results of the largest meta-analysis of optic nerve sheath fenestration, CSF diversion procedure, and venous sinus stent placement for medically refractory IIH from 1988 to present. We then compare these interventions with a focus on symptom improvement, complications, and the need for repeat procedures.…”

Stents for Idiopathic Intracranial Hypertension: Meta-Analyzed, Hypo-Analyzed, and In Need of a Trial

“…The power in both the 2013 review and the current meta-analysis lies in the 52-patient study by Ahmed et al, 3 in which CSF opening pressure, an essential criterion for the diagnosis of idiopathic intracranial hypertension (IIH), was not documented in either 11 or 9 patients depending on which meta-analysis one chooses to read. Likewise, the 2 studies with 15 patients each (Fields et al 4 and Albuquerque et al 5 ) did not record the CSF opening pressure for any of their included patients; and both the 4-patient study (Owler et al 6 ) and the 18-patient study (Kumpe et al 7 ) did not record CSF opening pressure in 1 and 4 patients, respectively. A study of 10 patients noted to be without recorded CSF opening pressures in the 2013 analysis (Bussière et al 8 ) is noted in Table 4 of the 2015 meta-analysis as having an opening pressure range of 25-50 cm H 2 0.…”

Reply:

“…Albuquerque et al did report, however, that elevated venous pressures were confirmed in all except 1 patient (18/19 patients). 3 In reference to the comments regarding Table 4, venous sinus stenting, Bussière et al 2 did report CSF opening pressures as a range between 25 and 50 cm H 2 O, which was provided in the body of the article under "Materials and Methods." Strict inclusion criteria were not commonly adhered to in the surgical modalities.…”