Scientific Oral Presentations: Rhinologic Procedures & Skull Base
ARS041 - Transverse venous sinus stenting in idiopathic intracranial hypertension
Friday, April 29, 2022
8:35 AM – 8:41 AM CT
Location: Landmark C
Sarah Khalife, MD; Pedro Escobedo, MS3; Joseph D. Morrison; Richard W. Crowley, MD; Stephan Munich, MD; Milena Stosic, MD; Aimee Szewka, MD; Peter Papagiannopoulos, MD; Pete Batra, MD, FARS; Bobby Tajudeen, MD, FARS
Background: Despite successful repair of CSF leaks associated with idiopathic intracranial hypertension (IIH), IIH remains a therapeutic challenge. Diuretics, CSF shunting, and optic nerve sheath fenestration are aimed at decreasing intracranial pressures (ICP). Transverse venous sinus stenting (TVSS) is an additional treatment modality for IIH patients with transverse sinus stenosis. This study aims to evaluate if stenting can reduce the risk of CSF leak and the need for subsequent ICP-reducing interventions.
Methods: A retrospective review of patients who underwent TVSS was performed. Demographics, clinical presentation, imaging characteristics, treatment modalities and complications were analyzed.
Results: 28 patients with transverse sinus stenosis who underwent TVSS were included. Mean age was 36 years, 93% were female, 64% had visual field defects, 75% had papilledema and mean opening pressure on lumbar puncture was 37mmH2O. 37% of patients treated with acetazolamide did not tolerate it. Following stent-placement, 23 patients (82%), did not require further ICP-lowering intervention over an average follow up period of 814 days. Only two patients (7%) required CSF leak repair and three (11%) VP shunt placement. Of four patients with skull base bone dehiscence on imaging, two developed CSF leak and required repair. The two patients with CSF leaks had similar characteristics with a BMI of 47, pulsatile tinnitus and headaches.
Conclusion: Our findings suggest that TVSS is a promising treatment modality for patients with IIH, notably in those who cannot tolerate medical therapy and possibly in the prevention of CSF leak in patients with bone dehiscence on skull base imaging. Further research is needed to confirm this role.