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Effect of Body Mass Index on Venous Sinus Pressures in Idiopathic Intracranial Hypertension Patients Before and After Endovascular Stenting.
Neurosurgery. 2018 04 01; 82(4):555-561.N

Abstract

BACKGROUND

Elevated body mass index (BMI) has been correlated with worse outcomes after treatment for idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a safe and effective treatment for a subset of patients with IIH and evidence of venous sinus stenosis. However, the association between BMI and the efficacy of VSS remains poorly characterized.

OBJECTIVE

To determine, in a retrospective cohort study, the effect of BMI on preoperative mean intracranial venous pressure (MVP) and post-VSS outcomes.

METHODS

We performed a retrospective evaluation of a prospectively collected database of patients with IIH and intracranial venous sinus stenosis who underwent VSS. Patient demographics and treatment factors, including pre- and postprocedural trans-stenosis pressure gradients, were analyzed to identify the relationship between BMI and outcomes after VSS.

RESULTS

Increasing BMI was significantly correlated with higher maximum MVP (P = .013) and higher trans-stenosis pressure gradient (P = .043) prior to treatment. The degrees of improvement in maximum MVP and pressure gradient after VSS were greatest for obese and morbidly obese patients (BMI > 30 kg/m2). Maximum poststent MVP, clinical outcomes, and stent-adjacent stenosis requiring retreatment after VSS were not significantly associated with BMI.

CONCLUSION

We provide direct evidence for a positive correlation between BMI and intracranial venous pressure in patients with IIH. VSS affords a significantly greater amelioration of intracranial venous hypertension and stenosis for IIH patients with higher BMIs. As such, obesity should not be a deterrent for the use of VSS in the management of IIH.

Authors+Show Affiliations

Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.De-partment of Neurological Surgery, Rush University Medical Center, Chicago, Illi-nois.Department of Neurosurgery, Uni-versity of Miami, Miami, Florida.Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. Depa-rtment of Radiology, University of Virginia, Charlottesville, Virginia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28431144

Citation

Raper, Daniel M S., et al. "Effect of Body Mass Index On Venous Sinus Pressures in Idiopathic Intracranial Hypertension Patients Before and After Endovascular Stenting." Neurosurgery, vol. 82, no. 4, 2018, pp. 555-561.
Raper DMS, Ding D, Buell TJ, et al. Effect of Body Mass Index on Venous Sinus Pressures in Idiopathic Intracranial Hypertension Patients Before and After Endovascular Stenting. Neurosurgery. 2018;82(4):555-561.
Raper, D. M. S., Ding, D., Buell, T. J., Crowley, R. W., Starke, R. M., & Liu, K. C. (2018). Effect of Body Mass Index on Venous Sinus Pressures in Idiopathic Intracranial Hypertension Patients Before and After Endovascular Stenting. Neurosurgery, 82(4), 555-561. https://doi.org/10.1093/neuros/nyx186
Raper DMS, et al. Effect of Body Mass Index On Venous Sinus Pressures in Idiopathic Intracranial Hypertension Patients Before and After Endovascular Stenting. Neurosurgery. 2018 04 1;82(4):555-561. PubMed PMID: 28431144.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Body Mass Index on Venous Sinus Pressures in Idiopathic Intracranial Hypertension Patients Before and After Endovascular Stenting. AU - Raper,Daniel M S, AU - Ding,Dale, AU - Buell,Thomas J, AU - Crowley,R Webster, AU - Starke,Robert M, AU - Liu,Kenneth C, PY - 2016/10/29/received PY - 2017/03/16/accepted PY - 2017/4/22/pubmed PY - 2019/9/10/medline PY - 2017/4/22/entrez SP - 555 EP - 561 JF - Neurosurgery JO - Neurosurgery VL - 82 IS - 4 N2 - BACKGROUND: Elevated body mass index (BMI) has been correlated with worse outcomes after treatment for idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a safe and effective treatment for a subset of patients with IIH and evidence of venous sinus stenosis. However, the association between BMI and the efficacy of VSS remains poorly characterized. OBJECTIVE: To determine, in a retrospective cohort study, the effect of BMI on preoperative mean intracranial venous pressure (MVP) and post-VSS outcomes. METHODS: We performed a retrospective evaluation of a prospectively collected database of patients with IIH and intracranial venous sinus stenosis who underwent VSS. Patient demographics and treatment factors, including pre- and postprocedural trans-stenosis pressure gradients, were analyzed to identify the relationship between BMI and outcomes after VSS. RESULTS: Increasing BMI was significantly correlated with higher maximum MVP (P = .013) and higher trans-stenosis pressure gradient (P = .043) prior to treatment. The degrees of improvement in maximum MVP and pressure gradient after VSS were greatest for obese and morbidly obese patients (BMI > 30 kg/m2). Maximum poststent MVP, clinical outcomes, and stent-adjacent stenosis requiring retreatment after VSS were not significantly associated with BMI. CONCLUSION: We provide direct evidence for a positive correlation between BMI and intracranial venous pressure in patients with IIH. VSS affords a significantly greater amelioration of intracranial venous hypertension and stenosis for IIH patients with higher BMIs. As such, obesity should not be a deterrent for the use of VSS in the management of IIH. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/28431144/Effect_of_Body_Mass_Index_on_Venous_Sinus_Pressures_in_Idiopathic_Intracranial_Hypertension_Patients_Before_and_After_Endovascular_Stenting_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1093/neuros/nyx186 DB - PRIME DP - Unbound Medicine ER -