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Effect of venous stenting on intracranial pressure in idiopathic intracranial hypertension

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Abstract

Background

Idiopathic intracranial hypertension (IIH) is characterised by an increased intracranial pressure (ICP) in the absence of any central nervous system disease or structural abnormality and by normal CSF composition. Management becomes complicated once surgical intervention is required. Venous sinus stenosis has been suggested as a possible aetiology for IIH. Venous sinus stenting has emerged as a possible interventional option. Evidence for venous sinus stenting is based on elimination of the venous pressure gradient and clinical response. There have been no studies demonstrating the immediate effect of venous stenting on ICP.

Methods

Patients with a potential or already known diagnosis of IIH were investigated according to departmental protocol. ICP monitoring was performed for 24 h. When high pressures were confirmed, CT venogram and catheter venography were performed to look for venous stenosis to demonstrate a pressure gradient. If positive, venous stenting would be performed and ICP monitoring would continue for a further 24 h after deployment of the venous stent.

Results

Ten patients underwent venous sinus stenting with concomitant ICP monitoring. Nine out of ten patients displayed an immediate reduction in their ICP that was maintained at 24 h. The average reduction in mean ICP and pulsatility was significant (p = 0.003). Six out of ten patients reported a symptomatic improvement within the first 2 weeks.

Conclusions

Venous sinus stenting results in an immediate reduction in ICP. This physiological response to venous stenting has not previously been reported. Venous stenting could offer an alternative treatment option in correctly selected patients with IIH.

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Authors and Affiliations

  1. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Samir A. Matloob, Ahmed K. Toma, Simon D. Thompson, Lewis Thorne & Laurence D. Watkins

  2. Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Chee L. Gan & Fergus Robertson

Authors
  1. Samir A. Matloob
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  2. Ahmed K. Toma
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  3. Simon D. Thompson
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  4. Chee L. Gan
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  5. Fergus Robertson
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  6. Lewis Thorne
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  7. Laurence D. Watkins
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Corresponding author

Correspondence to Samir A. Matloob.

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No funding was received for this research.

Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licencing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Matloob, S.A., Toma, A.K., Thompson, S.D. et al. Effect of venous stenting on intracranial pressure in idiopathic intracranial hypertension. Acta Neurochir 159, 1429–1437 (2017). https://doi.org/10.1007/s00701-017-3229-6

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  • DOI: https://doi.org/10.1007/s00701-017-3229-6

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