Abstract
The pathophysiology of IIH remains unknown. TS stenoses have been observed in a high proportion of these patients. Stent placement to remove this potential obstruction to venous outflow has been proposed as a treatment option for patients with IIH refractory to medical treatment. The clinical presentation, treatment, and outcome of patients with refractory IIH evaluated for venous sinus stent placement at a tertiary care center was retrospectively reviewed. Thirteen female patients with IIH were evaluated for sinovenous stent placement. Moderate sinus stenoses with normal intrasinus pressures were found in 3 patients and therefore stent placement was not performed. Ten patients had elevated intrasinus pressures (pressure gradient across stenosis, 11-50 mm Hg), which decreased following unilateral TS stent placement. Headaches improved or resolved in all stented patients. Papilledema resolved completely or almost completely in 8 patients and significantly improved in 2 patients. One patient developed optic atrophy. There were no major periprocedural complications. In this small case series, restoring the patency of stenotic venous sinuses with a stent in patients with refractory IIH resulted in symptomatic improvement in all treated patients. The safety and efficacy of this procedure should be evaluated in a randomized controlled study to determine its role within the armamentarium of therapeutic options for patients with IIH.
Highlights
AND PURPOSE: The pathophysiology of IIH remains unknown
Moderate sinus stenoses with normal intrasinus pressures were found in 3 patients and stent placement was not performed
There were no major periprocedural complications. In this small case series, restoring the patency of stenotic venous sinuses with a stent in patients with refractory IIH resulted in symptomatic improvement in all treated patients
Summary
The clinical presentation, treatment, and outcome of patients with refractory IIH evaluated for venous sinus stent placement at a tertiary care center was retrospectively reviewed. Thirteen patients with IIH referred to the interventional neuroradiology service at the London Health Sciences Centre for consideration of TS stent placement between 2001 and 2008 were retrospectively identified (on-line Table 1). Patients were referred if they had persistent or progressive optic neuropathy and/or intractable headaches despite maximally tolerated medical therapy as determined by a neuro-ophthalmologist (D.N. or A.P.) and/or neurologist. All patients suffered from headaches, most had visual symptoms (10/13), and pulsatile tinnitus was present in 3 out of 13 patients. Two patients (patients 7 and 12) presented with a rapidly progressive course and were considered for stent placement within 1 month of symptom onset. A recent lumbar puncture documented elevated CSF pressure in all patients ranging from 25 to 50 cm of water
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
