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Visual and neurological outcomes following endovascular stenting for pseudotumor cerebri associated with transverse sinus stenosis.
J Neuroophthalmol. 2013 Jun; 33(2):117-22.JN

Abstract

BACKGROUND

Pseudotumor cerebri (PTC) is characterized by raised intracranial pressure (ICP) without an identifiable mass, evidence of hydrocephalus, or abnormal cerebrospinal fluid content. In the past, most cases of PTC appeared to have no identifiable etiology, and thus, they were classified as "idiopathic intracranial hypertension" (IIH). Recently, however, a subset of patients with presumed IIH has been found to have evidence of cerebral dural sinus stenoses, particularly involving one or both transverse sinuses (TS). The belief that the stenoses are the cause, rather than an effect of the increased ICP, has led investigators to recommend stenting of the stenosed sinus for the treatment of the condition. We describe detailed visual and neurological outcomes after stenting for PTC associated with hemodynamically significant dural sinus stenosis.

METHODS

All patients with PTC had initial neurological, neuro-ophthalmological, and imaging assessments. Regardless of the findings, all were treated with medical therapy. If medical therapy failed and TS stenosis was detected on contrast-enhanced magnetic resonance or computed tomographic venography, catheter cerebral angiography with venous manometry was performed. If a mean pressure gradient (MPG) of 4 mm Hg or greater was present, unilateral transverse sinus stenting was performed.

RESULTS

Twelve patients with PTC and TS stenosis associated with an MPG of >4 mm Hg who failed medical therapy were identified. TS stenting significantly decreased the pressure gradient in all cases. Unilateral stenting was sufficient to reduce pressure gradients even when the stenosis was bilateral. At a mean follow-up of 16 months (range, 9-36 months), tinnitus had improved in all patients, and 10 of 12 patients had improvement in visual function. Seven patients had significant improvement in headaches.

CONCLUSION

In this small series of patients with PTC associated with TS stenosis, endovascular stent placement was generally effective in treating visual dysfunction and tinnitus, although not headaches. The optimum gradient and vascular characteristics amenable for selection of patients for stenting needs further research.

Authors+Show Affiliations

Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23502837

Citation

Radvany, Martin G., et al. "Visual and Neurological Outcomes Following Endovascular Stenting for Pseudotumor Cerebri Associated With Transverse Sinus Stenosis." Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society, vol. 33, no. 2, 2013, pp. 117-22.
Radvany MG, Solomon D, Nijjar S, et al. Visual and neurological outcomes following endovascular stenting for pseudotumor cerebri associated with transverse sinus stenosis. J Neuroophthalmol. 2013;33(2):117-22.
Radvany, M. G., Solomon, D., Nijjar, S., Subramanian, P. S., Miller, N. R., Rigamonti, D., Blitz, A., Gailloud, P., & Moghekar, A. (2013). Visual and neurological outcomes following endovascular stenting for pseudotumor cerebri associated with transverse sinus stenosis. Journal of Neuro-ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society, 33(2), 117-22. https://doi.org/10.1097/WNO.0b013e31827f18eb
Radvany MG, et al. Visual and Neurological Outcomes Following Endovascular Stenting for Pseudotumor Cerebri Associated With Transverse Sinus Stenosis. J Neuroophthalmol. 2013;33(2):117-22. PubMed PMID: 23502837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Visual and neurological outcomes following endovascular stenting for pseudotumor cerebri associated with transverse sinus stenosis. AU - Radvany,Martin G, AU - Solomon,David, AU - Nijjar,Satnam, AU - Subramanian,Prem S, AU - Miller,Neil R, AU - Rigamonti,Daniele, AU - Blitz,Ari, AU - Gailloud,Philippe, AU - Moghekar,Abhay, PY - 2013/3/19/entrez PY - 2013/3/19/pubmed PY - 2014/1/5/medline SP - 117 EP - 22 JF - Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society JO - J Neuroophthalmol VL - 33 IS - 2 N2 - BACKGROUND: Pseudotumor cerebri (PTC) is characterized by raised intracranial pressure (ICP) without an identifiable mass, evidence of hydrocephalus, or abnormal cerebrospinal fluid content. In the past, most cases of PTC appeared to have no identifiable etiology, and thus, they were classified as "idiopathic intracranial hypertension" (IIH). Recently, however, a subset of patients with presumed IIH has been found to have evidence of cerebral dural sinus stenoses, particularly involving one or both transverse sinuses (TS). The belief that the stenoses are the cause, rather than an effect of the increased ICP, has led investigators to recommend stenting of the stenosed sinus for the treatment of the condition. We describe detailed visual and neurological outcomes after stenting for PTC associated with hemodynamically significant dural sinus stenosis. METHODS: All patients with PTC had initial neurological, neuro-ophthalmological, and imaging assessments. Regardless of the findings, all were treated with medical therapy. If medical therapy failed and TS stenosis was detected on contrast-enhanced magnetic resonance or computed tomographic venography, catheter cerebral angiography with venous manometry was performed. If a mean pressure gradient (MPG) of 4 mm Hg or greater was present, unilateral transverse sinus stenting was performed. RESULTS: Twelve patients with PTC and TS stenosis associated with an MPG of >4 mm Hg who failed medical therapy were identified. TS stenting significantly decreased the pressure gradient in all cases. Unilateral stenting was sufficient to reduce pressure gradients even when the stenosis was bilateral. At a mean follow-up of 16 months (range, 9-36 months), tinnitus had improved in all patients, and 10 of 12 patients had improvement in visual function. Seven patients had significant improvement in headaches. CONCLUSION: In this small series of patients with PTC associated with TS stenosis, endovascular stent placement was generally effective in treating visual dysfunction and tinnitus, although not headaches. The optimum gradient and vascular characteristics amenable for selection of patients for stenting needs further research. SN - 1536-5166 UR - https://www.unboundmedicine.com/medline/citation/23502837/Visual_and_neurological_outcomes_following_endovascular_stenting_for_pseudotumor_cerebri_associated_with_transverse_sinus_stenosis_ L2 - https://doi.org/10.1097/WNO.0b013e31827f18eb DB - PRIME DP - Unbound Medicine ER -