Pseudotumor cerebri in its advanced form creates severe papilledema which can threaten vision or cause blindness. A subgroup of pseudotumor patients with this advanced clinical picture have intracranial dural sinus outflow obstruction which is completely reversible with elimination of the offending venous pressure gradient by stent placement over the focal lesion causing the gradient. This procedure corrects the underlying cause of the increased intracranial pressure. Traditional surgical corrections, including shunts—lumboperitoneal, ventriculoperitoneal or ventriculoatrial—and optic nerve sheath fenestration do not correct the underlying hemodynamic abnormality and have high failure rates in follow-up. Dural sinus stents, on the other hand, have remained uniformly patent and our patients’ papilledemas have not recurred. This procedure should replace traditional surgical approaches in appropriately selected patients. The presentation will focus on the clinical evaluation and selection of these patients for treatment. Our clinical results (currently 19 stent placements in 18 patients) will be presented, with follow-up extending to 10 years.
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Competing interests DK—Cook Inc, royalties.