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E-070 Acute visual decline treated with urgent venous sinus stenting as opposed to high volume csf diversion in patients with idiopathic intracranial hypotension
  1. G Deib1,
  2. A Moghekar2,
  3. M Luciano3,
  4. A El Mekabaty4,
  5. E Obusez5,
  6. B Barnett6,
  7. F Hui4
  1. 1Interventional Neuroradiology, Johns Hopkins Hospital, Baltimore, MD
  2. 2Neurology, Johns Hopkins Hospital, Baltimore, MD
  3. 3Neurosurgery, Johns Hopkins Hospital, Baltimore, MD
  4. 4Interventional Neuroradiology, Johns Hopkins Hospital, baltimore, MD
  5. 5Radiology, Cleveland Clinic Hospital, Cleveland, OH
  6. 6Ophthalmology, Johns Hopkins Hospital, baltimore, MD.

Abstract

Background and Purpose In severe cases of idiopathic intracranial hypertension (IIH), patients may present with life-altering papilledema and visual loss. IIH-associated optic neuropathy is a result of prolonged increased CSF pressure within the optic nerve sheath. The primary goal in managing patients with IIH is to avoid irreversible vision loss (in addition to reducing the intensity of other debilitating symptoms, such as severe headaches and tinnitus). The majority of patients with IIH have demonstrable venous sinus stenosis, potentially producing intracranial hypertension as a result of impaired CSF absorption. While the role of transverse sinus stenosis in IIH pathogenesis remains controversial, modeling studies and accumulating clinical experience suggests that stent placement within a transverse sinus stenosis with a significant pressure gradient decreases cerebral venous pressure, and may rapidly improve CSF pressure, improving the symptoms of IIH and reducing papilledema. As such, endovascular treatment of venous stenoses may be an effective alternative to CSF diversion and optic nerve sheath fenestration. Early clinical results illustrate comparable or superior results for both headache and visual symptoms after venous sinus stenting (VSS) in comparison with optic nerve sheath fenestration and CSF diversion. In a recent meta-analysis, VSS had higher rates of visual improvement and papilledema improvement than optic nerve sheath fenestration. We report three cases of acute visual decline treated by stent placement in transverse sinus stenosis with subsequent reversal of symptoms.

Materials and Methods We reviewed the clinical, venographic, ophthalmological and intracranial pressure data before and after stent placement in transverse sinus stenosis in 3 patients with IIH with acute visual decline unresponsive to maximum acceptable medical treatment.

Results Clinical, venographic, ophthalmological and intracranial pressure data demonstrated marked improvement following TSS.

Conclusions: Transverse sinus stenting appears to be an effective treatment alternative and may obviate CSF diversion in patients with acute visual deterioration due to IIH.

Disclosures: G. Deib: None. A. Moghekar: None. M. Luciano: None. A. El Mekabaty: None. E. Obusez: None. B. Barnett: None. F. Hui: None.

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