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Management of idiopathic intracranial hypertension in children utilizing venous sinus stenting.
Interv Neuroradiol. 2021 Apr; 27(2):257-265.IN

Abstract

BACKGROUND

Venous sinus stenting (VSS) is an accepted and minimally invasive treatment for adult idiopathic intracranial hypertension (IIH) associated with lateral sinus stenosis (LSS). The efficacy and safety of venous sinus stenting (VSS) in children with IIH has not been established.

METHODS

This is a retrospective analysis of IIH patients 18 years of age or younger with LSS treated with VSS at our institution. Included patients have fulminant disease course or are refractory or intolerant to medical management.

RESULTS

Eight patients were identified; 4 males and 4 females. Mean age is 13.4 years (range 4-18). All patients had severe headaches, 5 had blurred vision, 3 had diplopia and 3 had pulsatile tinnitus. Papilledema was present in 4 patients. Three patients had prior surgical procedures. Four patients were intolerant to medical management, 3 were refractory and 1 had fulminant course. Cerebral venography demonstrated severe stenosis of the dominant sinus in 6 patients and of bilateral co-dominant sinuses in 2 patients. Six patients had intrinsic stenosis and 2 had extrinsic stenosis. Venous sinus stenting (VSS) resulted in improvement of symptoms, papilledema and normalization of CSF opening pressure in 7 patients. No immediate complications were observed. Mean follow-up period is 21 months (range 6-42). Two patients required re-stenting; one responded well and the other had persistent symptoms and underwent subsequent surgical procedures of CSF diversion, suboccipital decompression and duraplasty which were also ineffective.

CONCLUSION

VSS may provide a viable option for pediatric IIH patients who are intolerant to medication, have failed conservative management or prior surgical interventions, or present with fulminant disease.

Authors+Show Affiliations

Department of Neurological Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA.Department of Neurological Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA.Department of Neurological Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA.Department of Ophthalmology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA.Department of Ophthalmology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA.Department of Neurological Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA.Department of Neurological Surgery, 24945North Shore University Hospital, Northwell Health, Manhasset, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33236688

Citation

Schwarz, Justin, et al. "Management of Idiopathic Intracranial Hypertension in Children Utilizing Venous Sinus Stenting." Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences, vol. 27, no. 2, 2021, pp. 257-265.
Schwarz J, Al Balushi A, Sundararajan S, et al. Management of idiopathic intracranial hypertension in children utilizing venous sinus stenting. Interv Neuroradiol. 2021;27(2):257-265.
Schwarz, J., Al Balushi, A., Sundararajan, S., Dinkin, M., Oliveira, C., Greenfield, J. P., & Patsalides, A. (2021). Management of idiopathic intracranial hypertension in children utilizing venous sinus stenting. Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences, 27(2), 257-265. https://doi.org/10.1177/1591019920976234
Schwarz J, et al. Management of Idiopathic Intracranial Hypertension in Children Utilizing Venous Sinus Stenting. Interv Neuroradiol. 2021;27(2):257-265. PubMed PMID: 33236688.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of idiopathic intracranial hypertension in children utilizing venous sinus stenting. AU - Schwarz,Justin, AU - Al Balushi,Ali, AU - Sundararajan,Sri, AU - Dinkin,Marc, AU - Oliveira,Cristiano, AU - Greenfield,Jeffrey P, AU - Patsalides,Athos, Y1 - 2020/11/25/ PY - 2020/11/26/pubmed PY - 2021/11/25/medline PY - 2020/11/25/entrez KW - Pediatric KW - idiopathic intracranial hypertension KW - papilledema KW - venous sinus stenting SP - 257 EP - 265 JF - Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences JO - Interv Neuroradiol VL - 27 IS - 2 N2 - BACKGROUND: Venous sinus stenting (VSS) is an accepted and minimally invasive treatment for adult idiopathic intracranial hypertension (IIH) associated with lateral sinus stenosis (LSS). The efficacy and safety of venous sinus stenting (VSS) in children with IIH has not been established. METHODS: This is a retrospective analysis of IIH patients 18 years of age or younger with LSS treated with VSS at our institution. Included patients have fulminant disease course or are refractory or intolerant to medical management. RESULTS: Eight patients were identified; 4 males and 4 females. Mean age is 13.4 years (range 4-18). All patients had severe headaches, 5 had blurred vision, 3 had diplopia and 3 had pulsatile tinnitus. Papilledema was present in 4 patients. Three patients had prior surgical procedures. Four patients were intolerant to medical management, 3 were refractory and 1 had fulminant course. Cerebral venography demonstrated severe stenosis of the dominant sinus in 6 patients and of bilateral co-dominant sinuses in 2 patients. Six patients had intrinsic stenosis and 2 had extrinsic stenosis. Venous sinus stenting (VSS) resulted in improvement of symptoms, papilledema and normalization of CSF opening pressure in 7 patients. No immediate complications were observed. Mean follow-up period is 21 months (range 6-42). Two patients required re-stenting; one responded well and the other had persistent symptoms and underwent subsequent surgical procedures of CSF diversion, suboccipital decompression and duraplasty which were also ineffective. CONCLUSION: VSS may provide a viable option for pediatric IIH patients who are intolerant to medication, have failed conservative management or prior surgical interventions, or present with fulminant disease. SN - 2385-2011 UR - https://www.unboundmedicine.com/medline/citation/33236688/Management_of_idiopathic_intracranial_hypertension_in_children_utilizing_venous_sinus_stenting_ L2 - https://journals.sagepub.com/doi/10.1177/1591019920976234?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -