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New devices and techniques
Case series
Major complications of dural venous sinus stenting for idiopathic intracranial hypertension: case series and management considerations
  1. Robert Kyle Townsend1,
  2. Alec Jost2,
  3. Matthew R Amans3,
  4. Ferdinand Hui4,
  5. Matthew T Bender5,
  6. Sudhakar R Satti6,
  7. Robert Maurer7,
  8. Kenneth Liu8,
  9. Waleed Brinjikji9,
  10. Kyle M Fargen10
  1. 1Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
  2. 2Wake Forest School of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  3. 3Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
  4. 4Radiology, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
  6. 6Neurointerventional Surgery, CCHS, Newark, Delaware, USA
  7. 7Neurosurgery, Penn State Health Neurosurgery, Hershey, Pennsylvania, USA
  8. 8Neurosurgery, University of Southern California, Los Angeles, California, USA
  9. 9Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  10. 10Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Robert Kyle Townsend, Neurological Surgery, Wake Forest University, Winston-Salem, NC 27157, USA; rktownse{at}wakehealth.edu

Abstract

Background Venous sinus stenting (VSS) is a safe, effective, and increasingly popular treatment option for selected patients with idiopathic intracranial hypertension (IIH). Serious complications associated with VSS are rarely reported.

Methods Serious complications after VSS were identified retrospectively from multicenter databases. The cases are presented and management strategies are discussed.

Results Six major acute and chronic complications after VSS were selected from a total of 811 VSS procedures and 1466 venograms for IIH. These included an acute subdural hematoma from venous extravasation, cases of both intraprocedural and delayed stent thrombosis, an ultimately fatal cerebellar hemorrhage resulting in acute obstructive hydrocephalus, venous microcatheter perforation during venography and manometry, and a patient who developed subarachnoid hemorrhage and subdural hematoma after cerebellar cortical vein perforation. The six cases are reviewed and learning points regarding complication avoidance and management are presented.

Conclusion We report on six rare, major complications after VSS for IIH. Familiarity with these potential complications and appropriate timely management may allow for good clinical outcomes.

  • stent
  • complication
  • vein

https://doi.org/10.1136/neurintsurg-2021-017361

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    Footnotes

    • Contributors KMF and RKT designed the study. KMF, MRA, FH, MTB, SRS, RM, KL, and WB contributed clinical cases and/or critical revisions to the cases, learning points, and discussion. RKT, KMF, and AJ contributed to the acquisition, analysis, and interpretation of data as well as drafting, revision, and submission of the manuscript. KMF conceived of the work and provided critical revisions and final review before submission.

    • 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 KMF- Associate Editor, Journal of Neurointerventional Surgery.

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