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Dural venous sinus stenting technique for idiopathic intracranial hypertension in patients with tortuous venous anatomy

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Abstract

Venous sinus stenting (VSS) for medically refractory idiopathic intracranial hypertension (IIH) is emerging as a safe and effective alternative to shunting. However, stent navigation past the jugular bulb with commonly used carotid stenting systems via femoral access in cases with tortuous venous anatomy can present a challenge, leading to procedural failure. We present a technical refinement using a cervical access and peripheral vascular stent with a more stable 0.035-in. delivery platform as an alternative to the traditional approach to simplify the procedure and overcome the technical difficulties in cases with tortuous venous anatomy. Our institutional database for patients who had IIH and undergone VSS using the peripheral vascular stent between 2013 and 2023 was retrospectively reviewed. Data on 36 patients (33 women, 3 men, mean age 32 years) was collected. VSS was technically successful in all patients (100%) without major complications or thrombosis. There was one case of minor neck cellulitis treated with oral antibiotics. Three patients underwent repeat stenting, and 2 patients had ventriculoperitoneal shunt placement after stenting due to persistent or recurrent symptoms. All patients (100%) had improvement or resolution of papilledema; however, six patients had evidence of optic atrophy and persistent vision loss. Headache was resolved or improved in 91% of patients. In the presence of tortuous venous anatomy, VSS using cervical access and a peripheral vascular stent with a more stable 0.035-in. delivery platform can be considered as a safe and effective alternative approach with shorter procedure time. This approach is particularly advantageous in situations where the procedure is prolonged or high dose of contrast has been administered due to the technical challenges associated with the traditional use of carotid systems via femoral access for stent delivery.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data is not publicly available due to privacy or ethical restrictions.

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Acknowledgements

The authors would like to acknowledge the support staff including the anesthesiologists, nurses, and interventional radiology technicians whose contributions make the management of patients safe and efficient.

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Authors and Affiliations

  1. University of New Mexico, Albuquerque, NM, 87131, USA

    Mehrnoush Gorjian, Jason E. Andrada, Kevin R. Sitko & Danielle E. Sorte

  2. UMCP Neurosurgery, 3502 9TH ST, Lubbock, TX, 79415, USA

    Christopher L. Taylor

  3. Saint Francis Hospital, Hartford, CT, 06105, USA

    Javed Khader Eliyas

  4. Department of Neurosurgery, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131, USA

    Andrew P. Carlson

Authors
  1. Mehrnoush Gorjian
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  2. Jason E. Andrada
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  3. Kevin R. Sitko
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  4. Danielle E. Sorte
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  6. Javed Khader Eliyas
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  7. Andrew P. Carlson
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Contributions

Mehrnoush Gorjian: study design, data analysis and interpretation, literature review, drafting, and finalizing the manuscript. Jason Andrada: study design, data collection. Kevin Sitko, Danielle Sorte, Christopher Taylor, and Javed Khader Eliyas: revising the manuscript. Andrew Carlson: study design, revising the manuscript, final review.

Corresponding author

Correspondence to Andrew P. Carlson.

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Ethical approval

This retrospective chart review study with waiver of informed consent was approved by the Institutional Review Board of University of New Mexico (approval number UNM HRPO 20-162).

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The authors declare no competing interests.

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Gorjian, M., Andrada, J.E., Sitko, K.R. et al. Dural venous sinus stenting technique for idiopathic intracranial hypertension in patients with tortuous venous anatomy. Neurosurg Rev 46, 177 (2023). https://doi.org/10.1007/s10143-023-02087-0

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  • DOI: https://doi.org/10.1007/s10143-023-02087-0

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