Introduction Venous sinus stenting (VSS) is increasingly being used as a treatment for idiopathic intracranial hypertension (IIH). This study aimed to look at long term outcomes and need for further surgical intervention in patients following VSS.
Methods Retrospective analysis was performed on a prospectively-maintained single center database to identify patients with medically refractory IIH who underwent VSS with associated pressure gradient. The senior author performs both VSS and CSF shunting for IIH. Patients with persistent or severe recurrent symptoms after VSS undergo lumbar puncture (LP) to evaluate the effect of VSS on intracranial pressures, therefore need for LP serves as a marker for disease recurrence.
Results 81 patients underwent VSS with a mean follow-up of 10 months (median 6 months, range 2 weeks – 38 months). Forty-four (54.3%) patients underwent repeat LP after VSS due to persistent or recurrent symptoms following the intervention at a mean of 12 months (median 7 months, range 2 – 43 months). There was a mean decrease in opening pressure (OP) on LP from pre- to post-VSS of 9.1 cm H2O (median 9.5 cm H2O). Of the 44 patients, 18 (22.2%) underwent repeat angiogram to evaluate for candidacy for repeat stenting, of which 5 (27.8%, 6.2% of total) patients underwent a second stenting procedure. Eighteen of the 44 (41.9%, 22.2% of total) patients underwent a subsequent CSF shunting procedure at a mean of 7.1 months (median 5.7 months) following VSS. Overall, a total of 21 (25.9%) patients underwent further surgical intervention following VSS. Forty-six patients were administered quality of life (WHOQOL-BREF) and symptom severity questionnaires (HIT-6) at initial consultation and each subsequent visit. There was an overall increase in quality of life scores with mean pre-stenting and last follow-up (post-VSS) scores of 61.2 (SEM 2.5) and 71.2 (SEM 3.9), respectively. There was an overall decrease in HIT-6 scores with mean pre-stenting and last follow-up (post-VSS) scores of 62.7 (SEM 1.7) and 55.8 (SEM 2.9), respectively.
Conclusions VSS is an effective treatment for venous sinus stenosis in IIH, however, this study found higher rates of symptomatic recurrence and need for further surgical intervention than has previously been reported in the literature. Recurrence of symptoms occurs at a median of 7 months even though OP remain lower at follow-up LP suggestive of a re-equilibration phenomenon.
Disclosures R. Garner: None. J. Aldridge: None. S. Wolfe: None. K. Fargen: None.
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