NCMP-18. ENDOVASCULAR TREATMENT OF SYMPTOMATIC TUMORAL VENOUS SINUS STENOSIS: COMPARATIVE ANALYSIS OF CORONARY BALLOON-MOUNTED STENTS AND CONVENTIONAL TECHNIQUES

Abstract

Abstract Meningiomas may lead to symptomatic papilledema due to elevated intracranial pressure (ICP) from venous sinus compression. While venous sinus stenting has proven effective for treating elevated intracranial pressure, evidence for its application in tumoral-induced stenosis and acquired intracranial hypertension is limited. This study presents an institutional series of symptomatic tumoral venous sinus stenosis cases and compares the technical considerations of endovascular treatment using a coronary balloon-mounted stent to conventional venous sinus stenting. Three patients with meningioma-induced, bilateral papilledema received treatment with venous sinus stenting between 2019-2022. Presentation, stenosis severity, venous manometry, ophthalmologic findings, procedural techniques, and post-operative outcomes were retrospectively analyzed. Three patients (mean age: 59 years, 2 out of 3 male) presented with worsening blurry vision, diplopia, and persistent headaches. Bilateral papilledema was observed (median optic nerve sheath distension=0.48mm). Pre-procedure measurements showed elevated ICP with opening pressures ranging from 37-38 cmH2O. Imaging revealed extra-axial parieto-occipital lesions with significant mass effect, and MR venograms confirmed severe stenosis of the superior sagittal sinus (SSS). Venous angiography (DSV) demonstrated median venous sinus pressures of 32-mmHg proximal to the stenosis with a 4-mmHg pressure gradient across the stenosis. During the procedure, balloon-mounted Onyx coronary stents or a self-expanding PrecisePro carotid stent were deployed successfully. Post-stenting, papilledema resolved completely in two patients, while one patient experienced partial symptom resolution. Proximal SSS pressures decreased by a mean of 46.8%, and trans-stenotic pressure gradients were reduced to ≤1 mmHg. Stent patency without complications was maintained throughout the 2 to 5-month follow-up in all patients. Adjacent meningiomas were subsequently monitored for observation or stereotactic radiosurgery. Small extra-axial lesions causing symptomatic venous sinus compression can be endovascularly treated using balloon-mounted cardiac stents. Non-surgical meningioma patients, symptomatic for intracranial hypertension and lesions proximal to venous sinuses, should be assessed with DSV for potential management with endovascular interventions.