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Transverse venous stenting for the treatment of idiopathic intracranial hypertension, or pseudotumor cerebri.
Neurosurg Focus. 2018 07; 45(1):E11.NF

Abstract

OBJECTIVE

Idiopathic intracranial hypertension (IIH) is a commonly occurring disease, particularly among young women of child-bearing age. The underlying pathophysiology for this disease has remained largely unclear; however, the recent literature suggests that focal outflow obstruction of the transverse sinus may be the cause. The purpose of this study was to report one group's early experience with transverse venous sinus stenting in the treatment of IIH and assess its effectiveness.

METHODS

The authors performed a retrospective chart review to identify patients who had undergone stenting of an outflow-obstructed transverse venous sinus for the treatment of IIH at Gates Vascular Institute between January 2015 and November 2017. Patient demographic data of interest included age, sex, BMI, and history of smoking, hypertension, obstructive sleep apnea, hormonal contraceptive use, and acetazolamide therapy. Each patient's presenting signs and symptoms and whether those symptoms improved with treatment were reviewed. The average opening lumbar puncture (LP) pressure preprocedure, average pressure gradient across the obstructed segment prior to stenting, treatment failure rate (need for shunt placement), and mean follow-up period were calculated.

RESULTS

Of the 18 patients who had undergone transverse venous stenting for IIH, 16 (88.9%) were women. The mean age of all the patients was 38.3 years (median 38 years). Mean BMI was 34.2 kg/m2 (median 33.9 kg/m2). Presenting symptoms were headache (16 patients [88.9%]), visual disturbances (13 patients [72.2%]), papilledema (8 patients [44.4%]), tinnitus (3 patients [16.7%]), and auditory bruit (3 patients [16.7%]). The mean opening LP pressure pre-procedure was 35.6 cm H2O (median 32 cm H2O). The mean pressure gradient measured proximally and distally to the area of focal obstruction within the transverse sinus was 16.5 cm H2O (median 15 cm H2O). Postprocedurally, 14 patients (77.8%) continued to have headaches; 6 (33.3%) continued to have visual disturbances. No patients continued to have auditory bruit (0%) or papilledema (0%). One patient (5.6%) had new-onset tinnitus postprocedure. Overall improvement of symptoms was noted in 16 patients (88.9%) postprocedure, with 1 patient (5.6%) requiring shunt placement and 2 other patients (11.1%) requiring postprocedural LP to monitor intracranial pressure to determine candidacy for further surgical interventions to treat residual symptoms. The mean duration of follow-up was 194.2 days.

CONCLUSIONS

Transverse sinus stenting is a rapidly developing technique that has shown good effectiveness and safety in the literature. Authors of the present study found that stenting a flow-obstructed transverse sinus in patients with IIH was a safe and effective way to treat the condition.

Authors+Show Affiliations

Departments of1Neurosurgery. 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health.5Jacobs School of Medicine at the University at Buffalo.Departments of1Neurosurgery. 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health.Departments of1Neurosurgery. 2Biomedical Informatics. 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health. 8Jacobs Institute, Buffalo, New York.Departments of1Neurosurgery. 3Neurology, and. 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health. 7Canon Stroke and Vascular Research Center at the University at Buffalo; and.Departments of1Neurosurgery. 4Radiology. 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health. 7Canon Stroke and Vascular Research Center at the University at Buffalo; and.Departments of1Neurosurgery. 4Radiology. 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health. 8Jacobs Institute, Buffalo, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29961386

Citation

Cappuzzo, Justin M., et al. "Transverse Venous Stenting for the Treatment of Idiopathic Intracranial Hypertension, or Pseudotumor Cerebri." Neurosurgical Focus, vol. 45, no. 1, 2018, pp. E11.
Cappuzzo JM, Hess RM, Morrison JF, et al. Transverse venous stenting for the treatment of idiopathic intracranial hypertension, or pseudotumor cerebri. Neurosurg Focus. 2018;45(1):E11.
Cappuzzo, J. M., Hess, R. M., Morrison, J. F., Davies, J. M., Snyder, K. V., Levy, E. I., & Siddiqui, A. H. (2018). Transverse venous stenting for the treatment of idiopathic intracranial hypertension, or pseudotumor cerebri. Neurosurgical Focus, 45(1), E11. https://doi.org/10.3171/2018.5.FOCUS18102
Cappuzzo JM, et al. Transverse Venous Stenting for the Treatment of Idiopathic Intracranial Hypertension, or Pseudotumor Cerebri. Neurosurg Focus. 2018;45(1):E11. PubMed PMID: 29961386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transverse venous stenting for the treatment of idiopathic intracranial hypertension, or pseudotumor cerebri. AU - Cappuzzo,Justin M, AU - Hess,Ryan M, AU - Morrison,John F, AU - Davies,Jason M, AU - Snyder,Kenneth V, AU - Levy,Elad I, AU - Siddiqui,Adnan H, PY - 2018/7/3/entrez PY - 2018/7/3/pubmed PY - 2019/10/17/medline KW - ICP = intracranial pressure KW - IIH = idiopathic intracranial hypertension KW - LP = lumbar puncture KW - PTC = pseudotumor cerebri KW - VSOO = venous sinus outflow obstruction KW - idiopathic intracranial hypertension KW - pseudotumor KW - stenting KW - transverse sinus SP - E11 EP - E11 JF - Neurosurgical focus JO - Neurosurg Focus VL - 45 IS - 1 N2 - OBJECTIVE Idiopathic intracranial hypertension (IIH) is a commonly occurring disease, particularly among young women of child-bearing age. The underlying pathophysiology for this disease has remained largely unclear; however, the recent literature suggests that focal outflow obstruction of the transverse sinus may be the cause. The purpose of this study was to report one group's early experience with transverse venous sinus stenting in the treatment of IIH and assess its effectiveness. METHODS The authors performed a retrospective chart review to identify patients who had undergone stenting of an outflow-obstructed transverse venous sinus for the treatment of IIH at Gates Vascular Institute between January 2015 and November 2017. Patient demographic data of interest included age, sex, BMI, and history of smoking, hypertension, obstructive sleep apnea, hormonal contraceptive use, and acetazolamide therapy. Each patient's presenting signs and symptoms and whether those symptoms improved with treatment were reviewed. The average opening lumbar puncture (LP) pressure preprocedure, average pressure gradient across the obstructed segment prior to stenting, treatment failure rate (need for shunt placement), and mean follow-up period were calculated. RESULTS Of the 18 patients who had undergone transverse venous stenting for IIH, 16 (88.9%) were women. The mean age of all the patients was 38.3 years (median 38 years). Mean BMI was 34.2 kg/m2 (median 33.9 kg/m2). Presenting symptoms were headache (16 patients [88.9%]), visual disturbances (13 patients [72.2%]), papilledema (8 patients [44.4%]), tinnitus (3 patients [16.7%]), and auditory bruit (3 patients [16.7%]). The mean opening LP pressure pre-procedure was 35.6 cm H2O (median 32 cm H2O). The mean pressure gradient measured proximally and distally to the area of focal obstruction within the transverse sinus was 16.5 cm H2O (median 15 cm H2O). Postprocedurally, 14 patients (77.8%) continued to have headaches; 6 (33.3%) continued to have visual disturbances. No patients continued to have auditory bruit (0%) or papilledema (0%). One patient (5.6%) had new-onset tinnitus postprocedure. Overall improvement of symptoms was noted in 16 patients (88.9%) postprocedure, with 1 patient (5.6%) requiring shunt placement and 2 other patients (11.1%) requiring postprocedural LP to monitor intracranial pressure to determine candidacy for further surgical interventions to treat residual symptoms. The mean duration of follow-up was 194.2 days. CONCLUSIONS Transverse sinus stenting is a rapidly developing technique that has shown good effectiveness and safety in the literature. Authors of the present study found that stenting a flow-obstructed transverse sinus in patients with IIH was a safe and effective way to treat the condition. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/29961386/Transverse_venous_stenting_for_the_treatment_of_idiopathic_intracranial_hypertension_or_pseudotumor_cerebri_ L2 - https://thejns.org/doi/10.3171/2018.5.FOCUS18102 DB - PRIME DP - Unbound Medicine ER -