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Dural venous sinus stenting for treatment of pediatric idiopathic intracranial hypertension.
J Neurointerv Surg. 2021 May; 13(5):465-470.JN

Abstract

BACKGROUND

Dural venous sinus stenting (VSS) is an effective treatment for idiopathic intracranial hypertension (IIH) in adult patients. There are no published series to date evaluating safety and efficacy of VSS in pediatric patients.

OBJECTIVE

To report on procedural device selection and technique as well as safety and efficacy of VSS for pediatric patients with medically refractory IIH due to underlying venous sinus stenosis.

METHODS

A multi-institutional retrospective case series identified patients with medically refractory IIH aged less than 18 years who underwent VSS.

RESULTS

14 patients were identified at four participating centers. Patient ages ranged from 10 to 17 years, and 10 patients (71.4%) were female. Mean body mass index was 25.7 kg/m2 (range 15.8-34.6 kg/m2). Stenting was performed under general endotracheal anesthesia in all except two patients. The average trans-stenotic gradient during diagnostic venography was 10.6 mm Hg. Patients had stents placed in the superior sagittal sinus, transverse sinus, sigmoid sinus, occipital sinus, and a combination. Average follow-up was 1.7 years after stenting. Six patients out of 10 (60%) had reduced medication dosing, 12 of 14 patients (85.7%) had improvements in headaches, two patients (100%) with pre-stent tinnitus had resolution of symptoms, and four (80%) of five patients with papilledema had improvement on follow-up ophthalmological examinations. Two patients (14.3%) developed postprocedural groin hematomas, one patient (7.1%) developed a groin pseudoaneurysm, and one patient (7.1%) had postprocedural groin bleeding. No other procedural complications occurred. Four patients (28.6%) required further surgical treatment (cerebrospinal shunting and/or stenting) after their first stenting procedure.

CONCLUSIONS

This series suggests that VSS is feasible in a pediatric population with IIH and has a low complication rate and good clinical outcomes.

Authors+Show Affiliations

Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Penn State Health Neurosurgery, Hershey, Pennsylvania, USA.Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.Cabarrus Eye Center, Concord, North Carolina, USA.Department of Neurological Surgery, Radiology and Mechanical Engineering, University of Washington, Seattle, Washington, USA.Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA kfargen@wakehealth.edu.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32732257

Citation

Lee, Katriel E., et al. "Dural Venous Sinus Stenting for Treatment of Pediatric Idiopathic Intracranial Hypertension." Journal of Neurointerventional Surgery, vol. 13, no. 5, 2021, pp. 465-470.
Lee KE, Zehri A, Soldozy S, et al. Dural venous sinus stenting for treatment of pediatric idiopathic intracranial hypertension. J Neurointerv Surg. 2021;13(5):465-470.
Lee, K. E., Zehri, A., Soldozy, S., Syed, H., Catapano, J. S., Maurer, R., Albuquerque, F. C., Liu, K. C., Wolfe, S. Q., Brown, S., Levitt, M. R., & Fargen, K. M. (2021). Dural venous sinus stenting for treatment of pediatric idiopathic intracranial hypertension. Journal of Neurointerventional Surgery, 13(5), 465-470. https://doi.org/10.1136/neurintsurg-2020-016183
Lee KE, et al. Dural Venous Sinus Stenting for Treatment of Pediatric Idiopathic Intracranial Hypertension. J Neurointerv Surg. 2021;13(5):465-470. PubMed PMID: 32732257.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dural venous sinus stenting for treatment of pediatric idiopathic intracranial hypertension. AU - Lee,Katriel E, AU - Zehri,Aqib, AU - Soldozy,Sauson, AU - Syed,Hasan, AU - Catapano,Joshua S, AU - Maurer,Robert, AU - Albuquerque,Felipe C, AU - Liu,Kenneth C, AU - Wolfe,Stacey Q, AU - Brown,Sandra, AU - Levitt,Michael R, AU - Fargen,Kyle M, Y1 - 2020/07/30/ PY - 2020/04/17/received PY - 2020/06/25/revised PY - 2020/07/02/accepted PY - 2020/8/1/pubmed PY - 2021/6/9/medline PY - 2020/8/1/entrez KW - catheter KW - intracranial pressure KW - pediatrics KW - stent KW - vein SP - 465 EP - 470 JF - Journal of neurointerventional surgery JO - J Neurointerv Surg VL - 13 IS - 5 N2 - BACKGROUND: Dural venous sinus stenting (VSS) is an effective treatment for idiopathic intracranial hypertension (IIH) in adult patients. There are no published series to date evaluating safety and efficacy of VSS in pediatric patients. OBJECTIVE: To report on procedural device selection and technique as well as safety and efficacy of VSS for pediatric patients with medically refractory IIH due to underlying venous sinus stenosis. METHODS: A multi-institutional retrospective case series identified patients with medically refractory IIH aged less than 18 years who underwent VSS. RESULTS: 14 patients were identified at four participating centers. Patient ages ranged from 10 to 17 years, and 10 patients (71.4%) were female. Mean body mass index was 25.7 kg/m2 (range 15.8-34.6 kg/m2). Stenting was performed under general endotracheal anesthesia in all except two patients. The average trans-stenotic gradient during diagnostic venography was 10.6 mm Hg. Patients had stents placed in the superior sagittal sinus, transverse sinus, sigmoid sinus, occipital sinus, and a combination. Average follow-up was 1.7 years after stenting. Six patients out of 10 (60%) had reduced medication dosing, 12 of 14 patients (85.7%) had improvements in headaches, two patients (100%) with pre-stent tinnitus had resolution of symptoms, and four (80%) of five patients with papilledema had improvement on follow-up ophthalmological examinations. Two patients (14.3%) developed postprocedural groin hematomas, one patient (7.1%) developed a groin pseudoaneurysm, and one patient (7.1%) had postprocedural groin bleeding. No other procedural complications occurred. Four patients (28.6%) required further surgical treatment (cerebrospinal shunting and/or stenting) after their first stenting procedure. CONCLUSIONS: This series suggests that VSS is feasible in a pediatric population with IIH and has a low complication rate and good clinical outcomes. SN - 1759-8486 UR - https://www.unboundmedicine.com/medline/citation/32732257/Dural_venous_sinus_stenting_for_treatment_of_pediatric_idiopathic_intracranial_hypertension_ L2 - https://jnis.bmj.com/cgi/pmidlookup?view=long&pmid=32732257 DB - PRIME DP - Unbound Medicine ER -