Dural sinus stent placement for idiopathic intracranial hypertension

Clinical article

View More View Less
  • 1 Departments of Radiology,
  • 2 Neurosurgery,
  • 3 Neurology, and
  • 4 Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The use of unilateral dural sinus stent placement in patients with idiopathic intracranial hypertension (IIH) has been described by multiple investigators. To date there is a paucity of information on the angiographic and hemodynamic outcome of these procedures. The object of this study was to define the clinical, angiographic, and hemodynamic outcome of placement of unilateral dural sinus stents to treat intracranial venous hypertension in a subgroup of patients meeting the diagnostic criteria for IIH.

Methods

Eighteen consecutive patients with a clinical diagnosis of IIH were treated with unilateral stent placement in the transverse-sigmoid junction region. All patients had papilledema. All 12 female patients had headaches; 1 of 6 males had headaches previously that disappeared after weight loss. Seventeen patients had elevated opening pressures at lumbar puncture. Twelve patients had opening pressures of 33–55 cm H2O. All patients underwent diagnostic cerebral arteriography that showed venous outflow compromise by filling defects in the transverse-sigmoid junction region. All patients underwent intracranial selective venous pressure measurements across the filling defects. Follow-up arteriography was performed in 16 patients and follow-up venography/venous pressure measurements were performed in 15 patients.

Results

Initial pressure gradients across the filling defects ranged from 10.5 to 39 mm Hg. Nineteen stent procedures were performed in 18 patients. One patient underwent repeat stent placement for hemodynamic failure. Pressure gradients were reduced in every instance and ranged from 0 to 7 mm Hg after stenting. Fifteen of 16 patients in whom ophthalmological follow-up was performed experienced disappearance of papilledema. Follow-up arteriography in 16 patients at 5–99 months (mean 25.3 months, median 18.5 months) showed patency of all stents without in-stent restenosis. Two patients had filling defects immediately above the stent. Four other patients developed transverse sinus narrowing above the stent without filling defects. One of these patients underwent repeat stent placement because of hemodynamic deterioration. Two of the other 3 patients had hemodynamic deterioration with recurrent pressure gradients of 10.5 and 18 mm Hg.

Conclusions

All stents remained patent without restenosis. Stent placement is durable and successfully eliminates papilledema in appropriately selected patients. Continuing hemodynamic success in this series was 80%, and was 87% with repeat stent placement in 1 patient.

Abbreviations used in this paper: AVM = arteriovenous malformation; BMI = body mass index; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension; ONSF = optic nerve sheath fenestration.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: David Kumpe, M.D., Department of Radiology, 12401 East 17th Avenue, Mail Stop L-954, Aurora, Colorado 80045. email: david.kumpe@ucdenver.edu.

Please include this information when citing this paper: published online December 9, 2011; DOI: 10.3171/2011.10.JNS101410.

  • 1

    Arac A, , Lee M, , Steinberg GK, , Marcellus M, & Marks MP: Efficacy of endovascular stenting in dural venous sinus stenosis for the treatment of idiopathic intracranial hypertension. Neurosurg Focus 27:5 E14, 2009

    • Search Google Scholar
    • Export Citation
  • 2

    Baryshnik DB, & Farb RI: Changes in the appearance of venous sinuses after treatment of disordered intracranial pressure. Neurology 62:14451446, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Bateman GA: Stenoses in idiopathic intracranial hypertension: to stent or not to stent?. AJNR Am J Neuroradiol 29:215216, 2008

  • 4

    Bono F, , Giliberto C, , Mastrandrea C, , Cristiano D, , Lavano A, & Fera F, : Transverse sinus stenoses persist after normalization of the CSF pressure in IIH. Neurology 65:10901093, 2005

    • Search Google Scholar
    • Export Citation
  • 5

    Bracard S, , Schmitt E, , Klein O, & Marchal JC: [“Benign” intracranial hypertension: neuroradiology and endovascular treatments.]. Neurochirurgie 54:721723, 2008. (Fr)

    • Search Google Scholar
    • Export Citation
  • 6

    Brazis PW: Clinical review: the surgical treatment of idiopathic pseudotumour cerebri (idiopathic intracranial hypertension). Cephalalgia 28:13611373, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Bussière M, , Falero R, , Nicolle D, , Proulx A, , Patel V, & Pelz D: Unilateral transverse sinus stenting of patients with idiopathic intracranial hypertension. AJNR Am J Neuroradiol 31:645650, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    Chandrasekaran S, , McCluskey P, , Minassian D, & Assaad N: Visual outcomes for optic nerve sheath fenestration in pseudotumour cerebri and related conditions. Clin Experiment Ophthalmol 34:661665, 2006

    • Search Google Scholar
    • Export Citation
  • 9

    Corbett JJ, & Digre K: Idiopathic intracranial hypertension: an answer to, “the chicken or the egg?. Neurology 58:56, 2002

  • 10

    Corbett JJ, , Nerad JA, , Tse DT, & Anderson RL: Results of optic nerve sheath fenestration for pseudotumor cerebri. The lateral orbitotomy approach. Arch Ophthalmol 106:13911397, 1988

    • Search Google Scholar
    • Export Citation
  • 11

    Donnet A, , Metellus P, , Levrier O, , Mekkaoui C, , Fuentes S, & Dufour H, : Endovascular treatment of idiopathic intracranial hypertension: clinical and radiologic outcome of 10 consecutive patients. Neurology 70:641647, 2008

    • Search Google Scholar
    • Export Citation
  • 12

    Farb RI, , Vanek I, , Scott JN, , Mikulis DJ, , Willinsky RA, & Tomlinson G, : Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 60:14181424, 2003

    • Search Google Scholar
    • Export Citation
  • 13

    Friedman DI: Cerebral venous pressure, intra-abdominal pressure, and dural venous sinus stenting in idiopathic intracranial hypertension. J Neuroophthalmol 26:6164, 2006

    • Search Google Scholar
    • Export Citation
  • 14

    Friedman DI, & Rausch EA: Headache diagnoses in patients with treated idiopathic intracranial hypertension. Neurology 58:15511553, 2002

    • Search Google Scholar
    • Export Citation
  • 15

    Higgins JN, , Cousins C, , Owler BK, , Sarkies N, & Pickard JD: Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry 74:16621666, 2003

    • Search Google Scholar
    • Export Citation
  • 16

    Higgins JN, , Gillard JH, , Owler BK, , Harkness K, & Pickard JD: MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood. J Neurol Neurosurg Psychiatry 75:621625, 2004

    • Search Google Scholar
    • Export Citation
  • 17

    Higgins JN, & Pickard JD: Lateral sinus stenoses in idiopathic intracranial hypertension resolving after CSF diversion. Neurology 62:19071908, 2004

    • Search Google Scholar
    • Export Citation
  • 18

    Johnston I, , Kollar C, , Dunkley S, , Assaad N, & Parker G: Cranial venous outflow obstruction in the pseudotumour syndrome: incidence, nature and relevance. J Clin Neurosci 9:273278, 2002

    • Search Google Scholar
    • Export Citation
  • 19

    Kesler A, , Hadayer A, , Goldhammer Y, , Almog Y, & Korczyn AD: Idiopathic intracranial hypertension: risk of recurrences. Neurology 63:17371739, 2004

    • Search Google Scholar
    • Export Citation
  • 20

    King JO, , Mitchell PJ, , Thomson KR, & Tress BM: Cerebral venography and manometry in idiopathic intracranial hypertension. Neurology 45:22242228, 1995

    • Search Google Scholar
    • Export Citation
  • 21

    King JO, , Mitchell PJ, , Thomson KR, & Tress BM: Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology 58:2630, 2002

    • Search Google Scholar
    • Export Citation
  • 22

    Leach JL, , Jones BV, , Tomsick TA, , Stewart CA, & Balko MG: Normal appearance of arachnoid granulations on contrast-enhanced CT and MR of the brain: differentiation from dural sinus disease. AJNR Am J Neuroradiol 17:15231532, 1996

    • Search Google Scholar
    • Export Citation
  • 23

    McGirt MJ, , Woodworth G, , Thomas G, , Miller N, , Williams M, & Rigamonti D: Cerebrospinal fluid shunt placement for pseudotumor cerebri-associated intractable headache: predictors of treatment response and an analysis of long-term outcomes. J Neurosurg 101:627632, 2004

    • Search Google Scholar
    • Export Citation
  • 24

    Métellus P, , Levrier O, , Fuentes S, , Adetchessi T, , Dufour H, & Donnet A, : [Endovascular treatment of benign intracranial hypertension by stent placement in the transverse sinus. Therapeutic and pathophysiological considerations illustrated by a case report.]. Neurochirurgie 51:113120, 2005. (Fr)

    • Search Google Scholar
    • Export Citation
  • 25

    Metellus P, , Levrier O, , Fuentes S, , N'Doye N, , Laghmari M, & Adetchessi T, : [Endovascular treatment of idiopathic intracranial hypertension. Analysis of eight consecutive patients]. Neurochirurgie 53:1017, 2007. (Fr)

    • Search Google Scholar
    • Export Citation
  • 26

    Ogungbo B, , Roy D, , Gholkar A, & Mendelow AD: Endovascular stenting of the transverse sinus in a patient presenting with benign intracranial hypertension. Br J Neurosurg 17:565568, 2003

    • Search Google Scholar
    • Export Citation
  • 27

    Owler BK, , Parker G, , Halmagyi GM, , Dunne VG, , Grinnell V, & McDowell D, : Pseudotumor cerebri syndrome: venous sinus obstruction and its treatment with stent placement. J Neurosurg 98:10451055, 2003

    • Search Google Scholar
    • Export Citation
  • 28

    Owler BK, , Parker G, , Halmagyi GM, , Johnston IH, , Besser M, & Pickard JD, : Cranial venous outflow obstruction and pseudotumor cerebri syndrome. Adv Tech Stand Neurosurg 30:107174, 2005

    • Search Google Scholar
    • Export Citation
  • 29

    Paquet C, , Poupardin M, , Boissonnot M, , Neau JP, & Drouineau J: Efficacy of unilateral stenting in idiopathic intracranial hypertension with bilateral venous sinus stenosis: a case report. Eur Neurol 60:4748, 2008

    • Search Google Scholar
    • Export Citation
  • 30

    Plotnik JL, & Kosmorsky GS: Operative complications of optic nerve sheath decompression. Ophthalmology 100:683690, 1993

  • 31

    Rajpal S, , Niemann DB, & Turk AS: Transverse venous sinus stent placement as treatment for benign intracranial hypertension in a young male: case report and review of the literature. J Neurosurg 102:3 Suppl 342346, 2005

    • Search Google Scholar
    • Export Citation
  • 32

    Randhawa S, & Van Stavern GP: Idiopathic intracranial hypertension (pseudotumor cerebri). Curr Opin Ophthalmol 19:445453, 2008

  • 33

    Rohr A, , Dörner L, , Stingele R, , Buhl R, , Alfke K, & Jansen O: Reversibility of venous sinus obstruction in idiopathic intracranial hypertension. AJNR Am J Neuroradiol 28:656659, 2007

    • Search Google Scholar
    • Export Citation
  • 34

    Sergott RC, , Savino PJ, & Bosley TM: Modified optic nerve sheath decompression provides long-term visual improvement for pseudotumor cerebri. Arch Ophthalmol 106:13841390, 1988

    • Search Google Scholar
    • Export Citation
  • 35

    Shah VA, , Kardon RH, , Lee AG, , Corbett JJ, & Wall M: Long-term follow-up of idiopathic intracranial hypertension: the Iowa experience. Neurology 70:634640, 2008

    • Search Google Scholar
    • Export Citation
  • 36

    Spoor TC, & McHenry JG: Long-term effectiveness of optic nerve sheath decompression for pseudotumor cerebri. Arch Ophthalmol 111:632635, 1993

    • Search Google Scholar
    • Export Citation
  • 37

    Spoor TC, , McHenry JG, & Shin DH: Long-term results using adjunctive mitomycin C in optic nerve sheath decompression for pseudotumor cerebri. Ophthalmology 102:20242028, 1995

    • Search Google Scholar
    • Export Citation
  • 38

    Tsumoto T, , Miyamoto T, , Shimizu M, , Inui Y, , Nakakita K, & Hayashi S, : Restenosis of the sigmoid sinus after stenting for treatment of intracranial venous hypertension: case report. Neuroradiology 45:911915, 2003

    • Search Google Scholar
    • Export Citation
  • 39

    Wall M: Idiopathic intracranial hypertension (pseudotumor cerebri). Curr Neurol Neurosci Rep 8:8793, 2008

  • 40

    Zheng H, , Zhou M, , Zhao B, , Zhou D, & He L: Pseudotumor cerebri syndrome and giant arachnoid granulation: treatment with venous sinus stenting. J Vasc Interv Radiol 21:927929, 2010

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 583 219 31
Full Text Views 331 72 2
PDF Downloads 205 52 0
EPUB Downloads 0 0 0