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Time to re-assess the treatment of idiopathic intracranial hypertension
  1. Felipe C Albuquerque,
  2. Bradley A Gross,
  3. Michael R Levitt
  1. Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  1. Correspondence to Dr Felipe C Albuquerque, Division of Neurological Surgery, Barrow Neurological Institute, 2910 N 3rd Ave, Phoenix, AZ 85013, USA; felipe.albuquerque{at}bnaneuro.net

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Patients with idiopathic intracranial hypertension (IIH) have debilitating headaches and, in severe cases, life-altering papilledema and visual loss.1 The time-honored approach of cerebrospinal fluid (CSF) diversion for medically refractory IIH is often complicated by patient body habitus and a small ventricular system.2 ,3 The majority of patients with IIH have demonstrable venous sinus stenosis, potentially producing intracranial hypertension as a result of impaired CSF absorption.4 ,5

Preliminary evidence suggests that venous sinus stenting (VSS) may be beneficial.3 ,6 Our own experience shows symptomatic improvement in 70% of patients after stenting with a high rate of stent patency and a low incidence of neurological complications.7 In addition, a follow-up study, a mean of 3 years after treatment, found continued patency and normal drainage of the vein of Labbe in all cases in which it had been covered by a stent.8

Recently, Satti et al3 performed a unique meta-analysis of interventional/surgical procedures performed for the treatment of medically refractory IIH. Results illustrated comparable or superior results for both headache and visual symptoms after VSS in comparison with optic nerve sheath fenestration and CSF diversion. The authors found 18 clinical studies with 712 …

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