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Clinical Neurology
Original research
Venous sinus stenting for idiopathic intracranial hypertension: a systematic review and meta-analysis
  1. Patrick Nicholson1,
  2. Waleed Brinjikji1,
  3. Ivan Radovanovic2,3,
  4. Christopher Alan Hilditch1,
  5. Anderson Chun On Tsang1,
  6. Timo Krings1,
  7. Vitor Mendes Pereira1,2,
  8. Stéphanie Lenck1,4
  1. 1 Joint Division of Medical Imaging, Department of Medical Imaging, UHN, University of Toronto, Toronto, Ontario, Canada
  2. 2 Division of Neurosurgery, Department of Surgery, UHN, University of Toronto, Toronto, Ontario, Canada
  3. 3 Krembil Neuroscience Institute, University of Toronto, Toronto, Ontario, Canada
  4. 4 Division of Neuroradiology, Groupe Hospitalier Pitié Salpêtrière, University Paris Sorbonne, Paris, France
  1. Correspondence to Dr Stéphanie Lenck, Service de Neuroradiologie, Groupe Hospitalier Pitié Salpêtrière, 47-83 Boulevard de l’Hôpital, Paris 75013, France; stephanie.lenck{at}orange.fr

Abstract

Background Stenting of the intracranial venous sinuses is used as a treatment in certain cases of idiopathic intracranial hypertension (IIH). Interest in, and experience of, this technique is growing, particularly in recent years. We sought to provide an updated systematic review and meta-analysis of the use of venous stenting in these patients, examining clinical outcomes.

Methods A literature search of venous stenting in IIH patients was performed. Using random-effects meta-analysis, we evaluated the following outcomes: clinical resolution of papilledema; headaches and pulsatile tinnitus; recurrence of symptoms after stenting; and complications.

Results Twenty articles from 18 different centers were included. In a total of 474 patients. 418 were female (88%). The mean age of the patients was 35, while the mean body mass index (BMI) was 35 kg/m2. Median follow-up was 18 months. The overall rate of improvement in papilloedema was 93.7% (95% CI 90.5% to 96.9%), while the overall rate of improvement or resolution of headache was 79.6% (95% CI 73.3% to 85.9%). Pulsatile tinnitus resolved in 90.3% (95% CI 83.8% to 96.70%), while the overall rate of recurrence of IIH symptoms after stenting was 9.8% (95% CI 6.7% to 13%). The rate of major complications was 1.9% (95% CI 0.07% to 3.1%).

Conclusions Venous sinus stenting in patients with IIH who are refractory to medical therapy appears to have an excellent safety profile and is associated with significant improvements in headaches, pulsatile tinnitus, and papilledema.

  • idiopathic intracranial hypertension
  • stent
  • vein
  • papilledema
  • headache

https://doi.org/10.1136/neurintsurg-2018-014172

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    Footnotes

    • Contributors All authors contributed equally to the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

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

    • Data sharing statement There are no additional unpublished data from the study.