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Venous sinus stenting shortens the duration of medical therapy for increased intracranial pressure secondary to venous sinus stenosis
  1. Tarek A Shazly1,
  2. Ashutosh P Jadhav2,
  3. Amin Aghaebrahim3,
  4. Andrew F Ducruet2,
  5. Brian T Jankowitz4,
  6. Tudor G Jovin2,
  7. Gabrielle R Bonhomme1
  1. 1Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3Baptist Health System, Jacksonville, Florida, USA
  4. 4Department of Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA 
  1. Correspondence to Dr Tarek A Shazly, University of Pittsburgh, Department of Ophthalmology, 203 Lothrop Street, Pittsburgh, PA 15213 USA; shazlyta{at}upmc.edu

Abstract

Introduction Medical treatment, cerebrospinal fluid (CSF) shunting, and optic nerve sheath fenestration are standard treatments for increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). Venous sinus stenting provides a novel alternative surgical treatment in cases of venous sinus stenosis with elevated ICP.

Methods 12 consecutive subjects with papilledema, increased ICP, and radiological signs of dural sinus stenosis underwent cerebral venography and manometry. All subjects had papilledema and demonstrated radiological evidence of dural venous sinus stenosis.

Results Six subjects chose venous stenting (Group A) and six declined and were managed conservatively with oral acetazolamide (Group B). The relative pressure gradient across the venous narrowing was 29±16.3 mm Hg in Group A and 17.6±9.3 mm Hg in Group B (p=0.09). The mean lumbar puncture opening pressure was 40.4±7.6 cm H2O in Group A and 35.6±10.6 cm H2O in Group B (p=0.4). Spectral domain optical coherence tomography (SD-OCT) showed mean average retinal nerve fiber layer (RNFL) thickness of 210±44.8 µm in Group A and 235±124.7 µm in Group B. However, the mean average RNFL thickness at 6 months was 85±9 µm in Group A and 95±24 µm in Group B (p=0.6). The total duration of acetazolamide treatment was 188±209 days in Group A compared with 571±544 days in Group B (p=0.07).

Conclusions In subjects with venous sinuses stenosis, endovascular stenting offers an effective treatment option for intracranial hypertension which may shorten the duration of medical therapy.

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Footnotes

  • Contributors TAS performed the data collection for the manuscript, cleaned and analyzed the data, and drafted the paper. APJ, AA, AFD, BTJ, TGJ and GRB reviewed and revised the manuscript.

  • Competing interests TGJ received a grant (non-financial) from Fundació Ictus Malaltia Vascular and honoraria from Silk Road (consultant), Medtronic and Stryker Neurovascular (consultant/advisory board), and J&J and Neuravi (consultant).

  • Patient consent Obtained.

  • Ethics approval Ethics approval was obtained from University of Pittsburgh Institutional Review Board.

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

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