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Case series
Quality of life, need for retreatment, and the re-equilibration phenomenon after venous sinus stenting for idiopathic intracranial hypertension
  1. Rebecca M Garner,
  2. Jennifer Bernhardt Aldridge,
  3. Stacey Q Wolfe,
  4. Kyle M Fargen
  1. Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, United States
  1. Correspondence to Dr Kyle M Fargen, Neurosurgery, Wake Forest University, Winston-Salem, NC 27109, USA; kfargen{at}wakehealth.edu

Abstract

Background Long term failure rates after venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) are poorly understood.

Methods Retrospective analysis was performed on a prospectively-maintained single center database to identify patients with medically refractory IIH who underwent VSS. Patients with persistent or severe recurrent symptoms after VSS undergo lumbar puncture (LP), therefore LP serves as a marker for treatment failure.

Results 81 patients underwent VSS with a mean follow-up of 10 months; 44 (54.3%) patients underwent LP after VSS due to persistent or recurrent symptoms at a mean of 12 months (median 7, range 2–43). There was a mean decrease in opening pressure (OP) on LP from pre- to post-VSS of 9.1 cm H2O (median 9.5). Overall, a total of 21 (25.9%) patients underwent further surgical intervention following VSS, including five who underwent repeat VSS (6.2% of total) and 18 who underwent cerebrospinal fluid shunting (22.2% of total). There was a non-significant (p=0.18) but overall increase in quality of life scores from pre-stenting (61.2) to last follow-up (71.2), and a significant decrease in Headache Impact Test-6 (HIT-6) scores (p=0.03) with mean pre-stenting and last follow-up scores of 62.7 and 55.8, 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 (26%) than previously reported in the literature. Recurrence of symptoms occurred at a median of 7 months, even though OP remained lower at follow-up LP, suggestive of a re-equilibration phenomenon.

  • intervention
  • intracranial pressure
  • stenosis
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Footnotes

  • Contributors Concept design: KMF. Data collection: RMG, JBA. Data review: RMG, KMF. Manuscript composition: RMG, KMF, SQW. Final approval of article: All authors.

  • 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 for publication Not required.

  • Ethics approval This study involved human participants and was approved by the Wake Forest University Institutional Review Boards, IRB00061472.

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

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