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Endovascular treatment of idiopathic intracranial hypertension: clinical and radiologic outcome of 10 consecutive patients.
Neurology. 2008 Feb 19; 70(8):641-7.Neur

Abstract

OBJECTIVE

To explore the relation between venous disease and idiopathic intracranial hypertension.

BACKGROUND

Optic nerve sheath fenestration and ventricular shunting are the classic methods when medical treatment has failed. Idiopathic intracranial hypertension is caused by venous sinus obstruction in an unknown percentage of cases. Recently, endoluminal venous sinus stenting was proposed as an alternative treatment.

METHODS

Ten consecutive patients with refractory idiopathic intracranial hypertension underwent examination with direct retrograde cerebral venography and manometry to characterize the morphologic features and venous pressures in their cerebral venous sinus. All patients demonstrated morphologic obstruction of the venous lateral sinuses. The CSF pressure was measured in all patients. The CSF pressure on lumbar puncture ranged from 27 to 45 mm Hg with normal composition. All patients had headache, and visual acuity loss was noted in eight patients. Funduscopic examination demonstrated papilledema for all patients. All patients had stenting of the venous sinuses. Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome.

RESULTS

Intrasinus pressures were invariably reduced by stenting. For headache, six patients were rendered asymptomatic, two were improved, and two were unchanged after venous sinus stenting for a mean (+/- SD) follow-up of 17 +/- 10.1 months (range 6 to 36 months). Papilledema disappeared in all patients. In all cases, CSF pressure was normalized at 3-month follow-up. In all patients, direct retrograde cerebral venography or multidetector row CT angiography was performed at 6-month follow-up and demonstrated the absence of stent thrombosis.

CONCLUSION

The importance of venous sinus disease in the etiology of idiopathic intracranial hypertension is probably underestimated. Patients with idiopathic intracranial hypertension in whom a venous sinus stenosis is demonstrated by a noninvasive radiologic workup should be evaluated with direct retrograde cerebral venography and manometry. In patients with a lesion of the venous sinuses who experienced medical treatment failure, endovascular stent placement seems to be an interesting alternative to classic surgical approaches.

Authors+Show Affiliations

Neurosurgical Department, Timone Hospital, Rue St Pierre, 13005 Marseille, France. adonnet@ap-hm.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

18285539

Citation

Donnet, A, et al. "Endovascular Treatment of Idiopathic Intracranial Hypertension: Clinical and Radiologic Outcome of 10 Consecutive Patients." Neurology, vol. 70, no. 8, 2008, pp. 641-7.
Donnet A, Metellus P, Levrier O, et al. Endovascular treatment of idiopathic intracranial hypertension: clinical and radiologic outcome of 10 consecutive patients. Neurology. 2008;70(8):641-7.
Donnet, A., Metellus, P., Levrier, O., Mekkaoui, C., Fuentes, S., Dufour, H., Conrath, J., & Grisoli, F. (2008). Endovascular treatment of idiopathic intracranial hypertension: clinical and radiologic outcome of 10 consecutive patients. Neurology, 70(8), 641-7. https://doi.org/10.1212/01.wnl.0000299894.30700.d2
Donnet A, et al. Endovascular Treatment of Idiopathic Intracranial Hypertension: Clinical and Radiologic Outcome of 10 Consecutive Patients. Neurology. 2008 Feb 19;70(8):641-7. PubMed PMID: 18285539.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovascular treatment of idiopathic intracranial hypertension: clinical and radiologic outcome of 10 consecutive patients. AU - Donnet,A, AU - Metellus,P, AU - Levrier,O, AU - Mekkaoui,C, AU - Fuentes,S, AU - Dufour,H, AU - Conrath,J, AU - Grisoli,F, PY - 2008/2/21/pubmed PY - 2008/4/4/medline PY - 2008/2/21/entrez SP - 641 EP - 7 JF - Neurology JO - Neurology VL - 70 IS - 8 N2 - OBJECTIVE: To explore the relation between venous disease and idiopathic intracranial hypertension. BACKGROUND: Optic nerve sheath fenestration and ventricular shunting are the classic methods when medical treatment has failed. Idiopathic intracranial hypertension is caused by venous sinus obstruction in an unknown percentage of cases. Recently, endoluminal venous sinus stenting was proposed as an alternative treatment. METHODS: Ten consecutive patients with refractory idiopathic intracranial hypertension underwent examination with direct retrograde cerebral venography and manometry to characterize the morphologic features and venous pressures in their cerebral venous sinus. All patients demonstrated morphologic obstruction of the venous lateral sinuses. The CSF pressure was measured in all patients. The CSF pressure on lumbar puncture ranged from 27 to 45 mm Hg with normal composition. All patients had headache, and visual acuity loss was noted in eight patients. Funduscopic examination demonstrated papilledema for all patients. All patients had stenting of the venous sinuses. Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome. RESULTS: Intrasinus pressures were invariably reduced by stenting. For headache, six patients were rendered asymptomatic, two were improved, and two were unchanged after venous sinus stenting for a mean (+/- SD) follow-up of 17 +/- 10.1 months (range 6 to 36 months). Papilledema disappeared in all patients. In all cases, CSF pressure was normalized at 3-month follow-up. In all patients, direct retrograde cerebral venography or multidetector row CT angiography was performed at 6-month follow-up and demonstrated the absence of stent thrombosis. CONCLUSION: The importance of venous sinus disease in the etiology of idiopathic intracranial hypertension is probably underestimated. Patients with idiopathic intracranial hypertension in whom a venous sinus stenosis is demonstrated by a noninvasive radiologic workup should be evaluated with direct retrograde cerebral venography and manometry. In patients with a lesion of the venous sinuses who experienced medical treatment failure, endovascular stent placement seems to be an interesting alternative to classic surgical approaches. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/18285539/Endovascular_treatment_of_idiopathic_intracranial_hypertension:_clinical_and_radiologic_outcome_of_10_consecutive_patients_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=18285539 DB - PRIME DP - Unbound Medicine ER -