Transverse sinus stenting without surgical repair in idiopathic CSF rhinorrhea associated with transverse sinus stenoses: a pilot study

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  • 1 Department of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, Paris;
  • | 2 GRC E-HTIC, Sorbonne University, Paris;
  • | 3 Department of Neurosurgery, Groupe Hospitalier Pitié Salpêtrière, Paris, France;
  • | 4 Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada;
  • | 5 Sorbonne Université, Paris; and
  • | 6 Department of Otolaryngology, Groupe Hospitalier Pitié Salpêtrière, Paris, France
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OBJECTIVE

Based on their clinical and radiological patterns, idiopathic CSF rhinorrhea and idiopathic intracranial hypertension can represent different clinical expressions of the same underlying pathological process. Transverse sinus stenoses are associated with both diseases, resulting in eventual restriction of the venous CSF outflow pathway. While venous sinus stenting has emerged as a promising treatment for idiopathic intracranial hypertension, its efficiency on idiopathic CSF leaks has not been very well addressed in the literature so far. The purpose of this study was to report the results of transverse sinus stenting in patients with spontaneous CSF rhinorrhea associated with transverse sinus stenoses.

METHODS

From a prospectively collected database, the authors retrospectively collected the clinical and radiological features of the patients with spontaneous CSF leakage who were treated with venous sinus stenting.

RESULTS

Five female patients were included in this study. Transverse sinus stenoses were present in all patients, and other radiological signs of idiopathic intracranial hypertension were present in 4 patients. The median transstenotic pressure gradient was 6.5 mm Hg (range 3–9 mm Hg). Venous stenting resulted in the disappearance of the leak in 4 patients with no recurrence and no subsequent meningitis during the follow-up (median 12 months, range 6–63 months).

CONCLUSIONS

According to the authors’ results, venous sinus stenting may result in the disappearance of the leak in many cases of idiopathic CSF rhinorrhea. Larger comparative studies are needed to assess the efficiency and safety of venous stenting as a first-line approach in patients with spontaneous CSF rhinorrhea associated with transverse sinus stenoses.

ABBREVIATIONS

CTV = CT venography; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension; MRV = MR venography; TS = transverse sinus; TSPG = transstenotic pressure gradient; TSS = TS stenosis; VSS = venous sinus stenting.

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