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Quality of life, need for retreatment, and the re-equilibration phenomenon after venous sinus stenting for idiopathic intracranial hypertension.
J Neurointerv Surg. 2021 Jan; 13(1):79-85.JN

Abstract

BACKGROUND

Long term failure rates after venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) are poorly understood.

METHODS

Retrospective analysis was performed on a prospectively-maintained single center database to identify patients with medically refractory IIH who underwent VSS. Patients with persistent or severe recurrent symptoms after VSS undergo lumbar puncture (LP), therefore LP serves as a marker for treatment failure.

RESULTS

81 patients underwent VSS with a mean follow-up of 10 months; 44 (54.3%) patients underwent LP after VSS due to persistent or recurrent symptoms at a mean of 12 months (median 7, range 2-43). There was a mean decrease in opening pressure (OP) on LP from pre- to post-VSS of 9.1 cm H2O (median 9.5). Overall, a total of 21 (25.9%) patients underwent further surgical intervention following VSS, including five who underwent repeat VSS (6.2% of total) and 18 who underwent cerebrospinal fluid shunting (22.2% of total). There was a non-significant (p=0.18) but overall increase in quality of life scores from pre-stenting (61.2) to last follow-up (71.2), and a significant decrease in Headache Impact Test-6 (HIT-6) scores (p=0.03) with mean pre-stenting and last follow-up scores of 62.7 and 55.8, respectively.

CONCLUSIONS

VSS is an effective treatment for venous sinus stenosis in IIH; however, this study found higher rates of symptomatic recurrence and need for further surgical intervention (26%) than previously reported in the literature. Recurrence of symptoms occurred at a median of 7 months, even though OP remained lower at follow-up LP, suggestive of a re-equilibration phenomenon.

Authors+Show Affiliations

Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA.Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA.Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA.Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA kfargen@wakehealth.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32611623

Citation

Garner, Rebecca M., et al. "Quality of Life, Need for Retreatment, and the Re-equilibration Phenomenon After Venous Sinus Stenting for Idiopathic Intracranial Hypertension." Journal of Neurointerventional Surgery, vol. 13, no. 1, 2021, pp. 79-85.
Garner RM, Aldridge JB, Wolfe SQ, et al. Quality of life, need for retreatment, and the re-equilibration phenomenon after venous sinus stenting for idiopathic intracranial hypertension. J Neurointerv Surg. 2021;13(1):79-85.
Garner, R. M., Aldridge, J. B., Wolfe, S. Q., & Fargen, K. M. (2021). Quality of life, need for retreatment, and the re-equilibration phenomenon after venous sinus stenting for idiopathic intracranial hypertension. Journal of Neurointerventional Surgery, 13(1), 79-85. https://doi.org/10.1136/neurintsurg-2020-016124
Garner RM, et al. Quality of Life, Need for Retreatment, and the Re-equilibration Phenomenon After Venous Sinus Stenting for Idiopathic Intracranial Hypertension. J Neurointerv Surg. 2021;13(1):79-85. PubMed PMID: 32611623.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quality of life, need for retreatment, and the re-equilibration phenomenon after venous sinus stenting for idiopathic intracranial hypertension. AU - Garner,Rebecca M, AU - Aldridge,Jennifer Bernhardt, AU - Wolfe,Stacey Q, AU - Fargen,Kyle M, Y1 - 2020/07/01/ PY - 2020/04/07/received PY - 2020/06/10/revised PY - 2020/06/11/accepted PY - 2020/7/3/pubmed PY - 2020/7/3/medline PY - 2020/7/3/entrez KW - intervention KW - intracranial pressure KW - stenosis SP - 79 EP - 85 JF - Journal of neurointerventional surgery JO - J Neurointerv Surg VL - 13 IS - 1 N2 - BACKGROUND: Long term failure rates after venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) are poorly understood. METHODS: Retrospective analysis was performed on a prospectively-maintained single center database to identify patients with medically refractory IIH who underwent VSS. Patients with persistent or severe recurrent symptoms after VSS undergo lumbar puncture (LP), therefore LP serves as a marker for treatment failure. RESULTS: 81 patients underwent VSS with a mean follow-up of 10 months; 44 (54.3%) patients underwent LP after VSS due to persistent or recurrent symptoms at a mean of 12 months (median 7, range 2-43). There was a mean decrease in opening pressure (OP) on LP from pre- to post-VSS of 9.1 cm H2O (median 9.5). Overall, a total of 21 (25.9%) patients underwent further surgical intervention following VSS, including five who underwent repeat VSS (6.2% of total) and 18 who underwent cerebrospinal fluid shunting (22.2% of total). There was a non-significant (p=0.18) but overall increase in quality of life scores from pre-stenting (61.2) to last follow-up (71.2), and a significant decrease in Headache Impact Test-6 (HIT-6) scores (p=0.03) with mean pre-stenting and last follow-up scores of 62.7 and 55.8, respectively. CONCLUSIONS: VSS is an effective treatment for venous sinus stenosis in IIH; however, this study found higher rates of symptomatic recurrence and need for further surgical intervention (26%) than previously reported in the literature. Recurrence of symptoms occurred at a median of 7 months, even though OP remained lower at follow-up LP, suggestive of a re-equilibration phenomenon. SN - 1759-8486 UR - https://www.unboundmedicine.com/medline/citation/32611623/Quality_of_life_need_for_retreatment_and_the_re_equilibration_phenomenon_after_venous_sinus_stenting_for_idiopathic_intracranial_hypertension_ L2 - https://jnis.bmj.com/cgi/pmidlookup?view=long&pmid=32611623 DB - PRIME DP - Unbound Medicine ER -
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