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Combined surgical repair and venous sinus stenting for patients with skull base encephaloceles secondary to dural venous sinus stenosis

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Abstract

Background

Chronically elevated intracranial pressure (ICP) seen in idiopathic intracranial hypertension (IIH) can cause the development of skull base encephaloceles and cerebrospinal fluid (CSF) leaks. Surgical repair and ventriculoperitoneal shunt (VPS) placement are mainstays of treatment. Venous sinus stenting (VSS) is a newly accepted treatment modality. The goal of this study was thus to determine if VSS can be used to treat symptoms and prevent recurrence after surgical encephalocele repair.

Methods

Retrospective chart review of patients that had surgical repair of encephaloceles followed by VSS for symptomatic stenosis with elevated pressure gradient.

Results

A total of 13 patients underwent a combined encephalocele repair and VSS. Seventy-two percent were female; 46% had headaches, 69% pulsatile tinnitus, and 92% CSF rhinorrhea or otorrhea. One had seizures. Mean lumbar opening pressure was 23.3 ± 2.6 cm H2O; the average sagittal-to-jugular pressure gradient was 12.7 ± 1.8 cmH2O and was elevated in all patients. Four patients had middle fossa craniotomy for repair of tegmen defect (one bilateral); one had a retrosigmoid craniotomy for repair of a sigmoid plate defect. Eight had an endoscopic endonasal repair for sphenoid or cribriform plate encephalocele. There were no VSS procedural complications or complications associated with dual antiplatelet therapy. One patient had meningitis after endoscopic repair that was treated with antibiotics. One patient had recurrence of both CSF leak and venous stenosis adjacent to the stent requiring repeat repair and VSS. There was no further recurrence.

Conclusion

In patients with dural sinus stenosis and encephaloceles requiring repair, VSS can be performed safely within weeks of surgery for relief of symptoms, resolution of underlying pathology, and prevention of CSF leak recurrence.

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Acknowledgements

The authors are grateful to Mr. Thom Graves for his skillful artwork.

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Authors and Affiliations

  1. Department of Neurological Surgery, NewYork-Presbyterian, Weill Cornell Medicine, 525 E 68th St, Box 99, New York, NY, 10065, USA

    Umberto Tosi, Alexander Ramos, Margherita Rampichini, Srikanth Boddu, Babacar Cisse, Athos Patsalides, Justin Schwarz, Theodore H. Schwartz & Rohan Ramakrishna

  2. Department of Otolaryngology, NewYork-Presbyterian, Weill Cornell Medicine, New York, NY, USA

    George Alexiades, Ashutosh Kacker, Abtin Tabaee & Theodore H. Schwartz

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  1. Umberto Tosi
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Tosi, U., Ramos, A., Rampichini, M. et al. Combined surgical repair and venous sinus stenting for patients with skull base encephaloceles secondary to dural venous sinus stenosis. Acta Neurochir 165, 2283–2292 (2023). https://doi.org/10.1007/s00701-023-05680-w

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