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Venous sinus stenting in patients without idiopathic intracranial hypertension
  1. Michael R Levitt1,2,3,
  2. Felipe C Albuquerque4,
  3. Bradley A Gross4,
  4. Karam Moon4,
  5. Ashutosh P Jadhav5,6,
  6. Andrew F Ducruet5,
  7. R Webster Crowley7
  1. 1Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
  2. 2Department of Radiology, University of Washington, Seattle, Washington, USA
  3. 3Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
  4. 4Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
  5. 5Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  6. 6Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  7. 7Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Michael R Levitt, c/o Neuroscience Publications, University of Washington, Box 359924, 325 9th Ave, Seattle, WA 98104, USA; publications{at}neurosurgery.washington.edu

Abstract

Background Venous sinus stenting is an effective treatment for patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis.

Objective To determine the usefulness of venous sinus stenting in the treatment of patients with symptomatic venous sinus stenosis without a diagnosis of IIH.

Methods We performed a retrospective review of a prospective multicenter database of patients undergoing venous sinus stenting between January 2008 and February 2016. Patients with acute dural venous sinus thrombosis, arteriovenous fistula or arteriovenous malformation, or IIH were excluded. Clinical, radiological, and ophthalmological information was recorded.

Results Nine patients met the inclusion criteria and underwent venous sinus stenting for symptomatic dural venous sinus stenosis. Reasons for treatment included isolated unilateral pulsatile tinnitus (n=1), congenital hydrocephalus (n=2), unilateral pulsatile tinnitus following prior venous sinus thrombosis (n=1), acquired hydrocephalus following dural sinus thrombosis (n=2), meningitis (n=2) and tumor invasion into the dural venous sinus (n=1). Six patients underwent lumbar puncture or shunt tap, and all of these patients had elevated intracranial pressure. All stenoses were located in the transverse sinus, transverse–sigmoid junction and/or jugular bulb, and all were treated with self-expanding bare-metal stents. At follow-up, clinical symptoms had resolved in all but two patients, both of whom had congenital hydrocephalus and pre-existing shunts. There was no significant in-stent stenosis, and patients with ophthalmological follow-up demonstrated improvement of papilledema.

Conclusions Dural venous sinus stenting may be an effective treatment for patients with symptomatic venous sinus stenosis without IIH in carefully selected cases, but may not be effective in resolving the symptoms of congenital hydrocephalus.

  • Vein
  • Stent
  • Stenosis
  • Intracranial Pressure
  • Hydrocephalus

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