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Title: Venous sinus stenting for idiopathic intracranial Hypertension – a case series.
e-poster Number: EPOS 28
Category: e Poster
Author Name: Dr. Gurtejsingh Sardar
Institute:
Co-Author Name:
Abstract :
Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated CSF pressure of unknown underlying etiology with a worldwide incidence of 12–20 per 100,000 / year, more commonly affecting young and obese women. Common presenting symptoms are headache, nausea with or without vomiting, and visual symptoms amongst others.
The treatment options for IIH includes weight loss, medical management, and surgical interventions that carry quite a few complications – like Optic nerve sheath fenestration (ONSF), CSF shunting through either a Ventriculoperitoneal shunt (VPS) or a Lumboperitoneal shunt.
Recently proposed mechanisms state stenosis of the dural venous sinuses as one of the causes of refractory IIH. Stenting of the transverse sinus with significant pressure gradient across the stenosis improves CSF resorption, and reduces the intracranial (CSF) pressure.
In our study, involving 10 patients with medically refractory IIH, over a period of 2 years, our study aimed at demonstrating the safety and efficiency of venous sinus stenting in cases where venous sinus stenosis is documented and trans-stenotic pressure gradient > 8mm Hg.
Diagnosis of IIH was based on the Modified Dandy Criteria. Patients with IIH had high superior sagittal sinus pressures and stenosis of the dominant transverse sinus (9 patients) and bilateral transverse sinuses (1 patient). Stent placement across the transverse sinus stenosis resulted in immediately normalized venous pressure gradient and symptomatic relief. The overall rate of improvement in papilledema was 92.5%, whereas the resolution of headache and blurring of vision was 100%. Four patients experienced subdural hematoma or subarachnoid hemorrhage (n=1) and all made a complete clinical recovery. Overall mortality rate was 0%. No patients developed recurrence of symptoms post stenting.
Stenting of Transverse sinus stenosis in patients with IIH who are refractory to medical therapy is associated with significant improvements in headaches, pulsatile tinnitus, and papilledema.
