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

Abstract

BACKGROUND AND PURPOSE:In medically refractory idiopathic intracranial hypertension, optic nerve sheath fenestration or CSF shunting is considered the next line of management. Venous sinus stenosis has been increasingly recognized as a treatable cause of elevated intracranial pressure in a subset of patients. In this article, we present the results of the largest meta-analysis of optic nerve sheath fenestration, CSF shunting, and dural venous sinus stenting. This is the only article that compares these procedures, to our knowledge.

Stent Survival and Stent-Adjacent Stenosis Rates following Venous Sinus Stenting for Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis

“…In contrast, relieving the focal stenosis seen in the intrinsic type of DVSS would likely not result in stent-adjacent stenosis as venous sinus stenting relieves the primary cause of IIH in these patients. We observed high rates for improvement of signs and symptoms associated with refractory IIH following venous stenting similar to another large meta-analysis [2]. Tinnitus and papilledema were symptoms associated with the highest likelihood of response to venous stenting.…”

“…Furthermore, it is thought that in cases where dural venous sinus stenosis (DVSS) is present both shunting and optic nerve sheath fenestration are providing only a temporary relief to the physiological problem at hand. More recently, there has been a growing body of evidence on the role of DVSS in the etiology of IIH [2]. Whether the DVSS is the cause or a consequence of increased ICP is still debated [3].…”

“…Current surgical treatments of refractory IIH including cerebrospinal fluid (CSF) diversion (shunting) and optic nerve fenestration are associated with high rates of complications (7.6 and 32.3%, 1.5 and 16.4% major and minor complications, respectively) and recurrence of IIH-related symptoms [2]. Furthermore, it is thought that in cases where dural venous sinus stenosis (DVSS) is present both shunting and optic nerve sheath fenestration are providing only a temporary relief to the physiological problem at hand.…”

New frontiers in venous sinus stenting: Illustrative cases

“…However, recent reports have detailed the successful treatment of patients with IIH by venous sinus stenting, which alleviated both headaches and visual symptoms [1][2][3][4]. Given these promising results, our report adds to the literature by illustrating the successful treatment of two variant forms of IIH with venous sinus stenting.…”

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

“…ow did the recent article by Satti et al 1 pass muster? A review of the status of venous sinus stent placement in 2013 2 included more patients with stents than the so-called meta-analysis review in your October 2015 issue.…”