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Risk factors for failed transverse sinus stenting in pseudotumor cerebri patients.
Clin Neurol Neurosurg. 2014 Dec; 127:75-8.CN

Abstract

BACKGROUND

Idiopathic intracranial hypertension (IIH) when no underlying etiology is found, is a clinical syndrome characterized by elevated intracranial pressure (ICP) (>25 cm H2O), which may lead to headaches and visual symptoms. In patients with IIH who are found to have transverse sinus stenosis, placement of a venous stent across the stenosis has been shown to lower ICP and to resolve the symptoms in several case series, with generally favorable results. In this study, we examine common risk factors associated with failure of transvenous stenting for IIH. If venous sinus stenting fails, CSF diversion should be considered as the next line of treatment.

METHODS

We retrospectively reviewed the records of eighteen patients diagnosed with IIH who underwent venous sinus stenting for transverse sinus stenosis with a mean pressure gradient (MPG) of at least 4 mmHg. Fifteen of these patients did not need further treatment. We compared their pre- and post-treatment, neurological and neuro-ophthalmological evaluations to the three patients who went on to have a shunt placement as a second line treatment.

RESULTS

Shunting after stent placement patients (n=3) had a mean age of 30 years and a mean body mass index of 36.6 kg/m(2), whereas the group that underwent stent placement alone (n=15) had a mean age of 40.7 years and a mean body mass index of 33.3 kg/m(2). In the shunting after stent placement group, the mean opening pressure on the most recent lumbar puncture obtained prior to any intervention was 50 cm of H2O, whereas the group that underwent stent placement alone had an opening CSF pressure of 37 cm of H2O which was statistically significant (p<0.05). There were no other significant differences in pre- or post-intervention factors between the two groups.

CONCLUSION

In patients with IIH and documented evidence of venous sinus stenosis with a pressure gradient, venous sinus stenting should be the primary treatment of choice; however, some patients may be refractory to stenting and still require permanent CSF diversion, which can be complicated in these chronically anticoagulated patients. Patients with persistent papilledema post-stenting and highly elevated opening pressure pre-stenting should be followed closely as they are at greatest risk of requiring a shunt and failing stenting.

Authors+Show Affiliations

The Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, USA. Electronic address: rory@jhmi.edu.The Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, USA.The Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, USA.The Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, USA.The Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, USA.The Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, USA.The Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, USA.The Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, USA.The Johns Hopkins Hospital, Department of Neurosurgery, Baltimore, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25459247

Citation

Goodwin, C Rory, et al. "Risk Factors for Failed Transverse Sinus Stenting in Pseudotumor Cerebri Patients." Clinical Neurology and Neurosurgery, vol. 127, 2014, pp. 75-8.
Goodwin CR, Elder BD, Ward A, et al. Risk factors for failed transverse sinus stenting in pseudotumor cerebri patients. Clin Neurol Neurosurg. 2014;127:75-8.
Goodwin, C. R., Elder, B. D., Ward, A., Orkoulas-Razis, D., Kosztowski, T. A., Hoffberger, J., Moghekar, A., Radvany, M., & Rigamonti, D. (2014). Risk factors for failed transverse sinus stenting in pseudotumor cerebri patients. Clinical Neurology and Neurosurgery, 127, 75-8. https://doi.org/10.1016/j.clineuro.2014.09.015
Goodwin CR, et al. Risk Factors for Failed Transverse Sinus Stenting in Pseudotumor Cerebri Patients. Clin Neurol Neurosurg. 2014;127:75-8. PubMed PMID: 25459247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for failed transverse sinus stenting in pseudotumor cerebri patients. AU - Goodwin,C Rory, AU - Elder,Benjamin D, AU - Ward,Ayobami, AU - Orkoulas-Razis,Dennis, AU - Kosztowski,Thomas A, AU - Hoffberger,Jamie, AU - Moghekar,Abhay, AU - Radvany,Martin, AU - Rigamonti,Daniele, Y1 - 2014/10/06/ PY - 2014/08/12/received PY - 2014/09/18/revised PY - 2014/09/24/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/8/4/medline KW - CSF diversion KW - Idiopathic intracranial hypertension KW - Pseudotumor cerebri KW - Shunt KW - Venous sinus stenting SP - 75 EP - 8 JF - Clinical neurology and neurosurgery JO - Clin Neurol Neurosurg VL - 127 N2 - BACKGROUND: Idiopathic intracranial hypertension (IIH) when no underlying etiology is found, is a clinical syndrome characterized by elevated intracranial pressure (ICP) (>25 cm H2O), which may lead to headaches and visual symptoms. In patients with IIH who are found to have transverse sinus stenosis, placement of a venous stent across the stenosis has been shown to lower ICP and to resolve the symptoms in several case series, with generally favorable results. In this study, we examine common risk factors associated with failure of transvenous stenting for IIH. If venous sinus stenting fails, CSF diversion should be considered as the next line of treatment. METHODS: We retrospectively reviewed the records of eighteen patients diagnosed with IIH who underwent venous sinus stenting for transverse sinus stenosis with a mean pressure gradient (MPG) of at least 4 mmHg. Fifteen of these patients did not need further treatment. We compared their pre- and post-treatment, neurological and neuro-ophthalmological evaluations to the three patients who went on to have a shunt placement as a second line treatment. RESULTS: Shunting after stent placement patients (n=3) had a mean age of 30 years and a mean body mass index of 36.6 kg/m(2), whereas the group that underwent stent placement alone (n=15) had a mean age of 40.7 years and a mean body mass index of 33.3 kg/m(2). In the shunting after stent placement group, the mean opening pressure on the most recent lumbar puncture obtained prior to any intervention was 50 cm of H2O, whereas the group that underwent stent placement alone had an opening CSF pressure of 37 cm of H2O which was statistically significant (p<0.05). There were no other significant differences in pre- or post-intervention factors between the two groups. CONCLUSION: In patients with IIH and documented evidence of venous sinus stenosis with a pressure gradient, venous sinus stenting should be the primary treatment of choice; however, some patients may be refractory to stenting and still require permanent CSF diversion, which can be complicated in these chronically anticoagulated patients. Patients with persistent papilledema post-stenting and highly elevated opening pressure pre-stenting should be followed closely as they are at greatest risk of requiring a shunt and failing stenting. SN - 1872-6968 UR - https://www.unboundmedicine.com/medline/citation/25459247/Risk_factors_for_failed_transverse_sinus_stenting_in_pseudotumor_cerebri_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0303-8467(14)00377-1 DB - PRIME DP - Unbound Medicine ER -