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Original research
Dural venous sinus stenting for treatment of pediatric idiopathic intracranial hypertension
  1. Katriel E Lee1,
  2. Aqib Zehri1,
  3. Sauson Soldozy2,
  4. Hasan Syed2,
  5. Joshua S Catapano3,
  6. Robert Maurer4,
  7. Felipe C Albuquerque3,
  8. Kenneth C Liu5,
  9. Stacey Q Wolfe1,
  10. Sandra Brown6,
  11. Michael R Levitt7,
  12. Kyle M Fargen1
  1. 1Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
  2. 2Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
  3. 3Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  4. 4Penn State Health Neurosurgery, Hershey, Pennsylvania, USA
  5. 5Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
  6. 6Cabarrus Eye Center, Concord, North Carolina, USA
  7. 7Department of Neurological Surgery, Radiology and Mechanical Engineering, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Kyle M Fargen, Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27109, USA; kfargen{at}wakehealth.edu

Abstract

Background Dural venous sinus stenting (VSS) is an effective treatment for idiopathic intracranial hypertension (IIH) in adult patients. There are no published series to date evaluating safety and efficacy of VSS in pediatric patients.

Objective To report on procedural device selection and technique as well as safety and efficacy of VSS for pediatric patients with medically refractory IIH due to underlying venous sinus stenosis.

Methods A multi-institutional retrospective case series identified patients with medically refractory IIH aged less than 18 years who underwent VSS.

Results 14 patients were identified at four participating centers. Patient ages ranged from 10 to 17 years, and 10 patients (71.4%) were female. Mean body mass index was 25.7 kg/m2 (range 15.8–34.6 kg/m2). Stenting was performed under general endotracheal anesthesia in all except two patients. The average trans-stenotic gradient during diagnostic venography was 10.6 mm Hg. Patients had stents placed in the superior sagittal sinus, transverse sinus, sigmoid sinus, occipital sinus, and a combination. Average follow-up was 1.7 years after stenting. Six patients out of 10 (60%) had reduced medication dosing, 12 of 14 patients (85.7%) had improvements in headaches, two patients (100%) with pre-stent tinnitus had resolution of symptoms, and four (80%) of five patients with papilledema had improvement on follow-up ophthalmological examinations. Two patients (14.3%) developed postprocedural groin hematomas, one patient (7.1%) developed a groin pseudoaneurysm, and one patient (7.1%) had postprocedural groin bleeding. No other procedural complications occurred. Four patients (28.6%) required further surgical treatment (cerebrospinal shunting and/or stenting) after their first stenting procedure.

Conclusions This series suggests that VSS is feasible in a pediatric population with IIH and has a low complication rate and good clinical outcomes.

  • catheter
  • intracranial pressure
  • pediatrics
  • stent
  • vein
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Footnotes

  • Twitter @DrMichaelLevitt

  • Contributors Conception and design: AZ, KEL, KMF. Data Collection: AZ, FCA, JSC, KCL, KEL, KMF, RM, SS. Manuscript composition: All authors. Critical review: All authors. Final approval: 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.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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