Cerebral venous sinus system and stenting in pseudotumor cerebri

Abstract

The pathogenesis and treatment paradigm for idiopathic intracranial hypertension (IIH) is controversial. The goal of this article is to review the current literature addressing a relatively new and controversial therapeutic approach for a subset of IIH patients: dural venous sinus stenting. The debate continues as to whether transverse sinus stenosis is a primary or secondary process relative to raised intracranial pressure (ICP). Transverse sinus stenosis is seen in the majority of patients with IIH and appears to play some role in the disease process. Recent case reports and case series that looked at patients treated with venous sinus stents show encouraging results in decreasing ICP and its related signs and symptoms. Venous sinus stenting could be a treatment option for many patients with IIH. Exactly where in the treatment paradigm endovascular venous sinus stenting falls is unknown. Additional work, preferably controlled prospective studies, needs to be performed to prove its safety and efficacy. Finally, venous sinus stenting should be compared in head-to-head trials with optic nerve sheath fenestration and cerebrospinal fluid diversion surgeries to address its superiority or inferiority relative to these more traditional surgical options.