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Venous Sinus Stenting for Idiopathic Intracranial Hypertension

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Introduction to Vascular Neurosurgery

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Abstract

Idiopathic intracranial hypertension (IIH) is a condition of increased intracranial pressure (ICP) with a wide range of symptoms. No single unifying theory for the pathogenesis of IIH exists, but intracranial venous stenosis and congestion have been implicated. Diagnostic procedures to rule out venous sinus stenosis and trans-stenotic pressure gradients have become a part of the standard IIH work-up. Venous sinus stenosis in IIH is invariable localized to the region of the transverse-sigmoid junction, and it is frequently bilateral. Intrinsic stenosis is caused by fixed anatomic variations, whereas extrinsic stenosis induces a feedback loop in which mild ICP elevation deform venous sinus walls, causing outflow obstruction and further elevations in ICP. Venous sinus stenting is an effective endovascular treatment for appropriately selected IIH patients. However, researchers continue to investigate optimal thresholds for the degree of angiographic stenosis and magnitude of trans-stenosis gradient. Adverse events for venous sinus stenting are generally low, and procedural considerations regarding timing of diagnostic angiography, use of sedation, anticoagulant/antiplatelet agents, stent selection, and laterality remain largely a matter of institutional preference and an area of active investigation.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA

    Abigail P. McCallum & Dale Ding

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  1. Abigail P. McCallum
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  2. Dale Ding
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Correspondence to Dale Ding .

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Editors and Affiliations

  1. Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Justin R. Mascitelli

  2. Global Neurosciences Institute, Drexel University, Pennington, NJ, USA

    Mandy J. Binning

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McCallum, A.P., Ding, D. (2022). Venous Sinus Stenting for Idiopathic Intracranial Hypertension. In: Mascitelli, J.R., Binning, M.J. (eds) Introduction to Vascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-88196-2_25

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  • DOI: https://doi.org/10.1007/978-3-030-88196-2_25

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  • Online ISBN: 978-3-030-88196-2

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