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Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension
  1. Jeremy D Fields1,
  2. Parisa P Javedani2,
  3. Julie Falardeau3,
  4. Gary M Nesbit1,
  5. Aclan Dogan1,
  6. Erek K Helseth1,
  7. Kenneth C Liu4,
  8. Stanley L Barnwell1,
  9. Bryan D Petersen1
  1. 1Department of Interventional Neuroradiology, Oregon Health and Science University, Portland, Oregon, USA
  2. 2School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
  3. 3Department of Neuro-ophthalmology, Oregon Health and Science University, Portland, Oregon, USA
  4. 4Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
  1. Correspondence to Dr Jeremy D Fields, Department of Interventional Neuroradiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, CR-127, Portland, OR 97239, USA; fieldsje{at}ohsu.edu

Abstract

Background Lumboperitoneal shunt (LPS), ventriculoperitoneal shunt (VPS) and optic nerve sheath fenestration (ONSF) are accepted surgical therapies for medically refractory idiopathic intracranial hypertension (IIH). In the subset of patients with IIH and venous sinus stenosis, dural venous sinus stenting has emerged as an alternative surgical approach.

Methods All cases of dural stents for IIH at our institution were retrospectively reviewed. Eligibility criteria included medically refractory IIH with documented papilledema and dural venous sinus stenosis of the dominant venous outflow system (gradient ≥10 mm Hg).

Results Fifteen cases (all women) of mean age 34 years were identified. All had failed medical therapy and six had failed surgical intervention. Technical success was achieved in all patients without major periprocedural complications. The mean preprocedural gradient across the venous stenosis was reduced from 24 mm Hg before the procedure to 4 mm Hg after the procedure. Headache resolved or improved in 10 patients. Papilledema resolved in all patients and visual acuity stabilized or improved in 14 patients. There were no instances of restenosis among the 14 patients with follow-up imaging.

Conclusion In this small case series, dural sinus stenting for IIH was performed safely with a high degree of technical success and with excellent clinical outcomes. These results suggest that angioplasty and stenting for the treatment of medically refractory IIH in patients with dural sinus stenosis warrants further investigation as an alternative to LPS, VPS and ONSF.

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Footnotes

  • Competing interests None.

  • Patient consent Because this is a retrospective study with information derived from retrospective chart review, no consent was necessary from the patients. All data were deidentified/anonymized and acquired and stored in a manner designed to protect patient confidentiality in accordance with the policies of the IRB.

  • Ethics approval Ethics approval was obtained from the Oregon Health and Science University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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