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An update on the management of pseudotumor cerebri

Michael A Galgano1, Eric M Deshaies

  • 1Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA.

Clinical Neurology and Neurosurgery
|December 26, 2012
PubMed

Insights

Pseudotumor cerebri (benign intracranial hypertension) causes disabling headaches and vision loss. Treatment options include medications, surgery, and endovascular venous stent placement for dural sinus issues.

Area of Science:

  • Neurology
  • Neurosurgery
  • Vascular Neurology

Background:

  • Pseudotumor cerebri (PTC), or benign intracranial hypertension (BIH), presents as increased intracranial pressure of unknown cause.
  • It predominantly affects obese women under 45, causing debilitating headaches and visual disturbances.
  • Medical management aims to reduce intracranial pressure (ICP) via CSF production inhibitors or volume reduction.

Purpose of the Study:

  • To review the clinical presentation of pseudotumor cerebri.
  • To discuss medical, surgical, and endovascular treatment modalities for PTC.
  • To educate readers on the pathophysiology and management of BIH.

Main Methods:

  • Review of clinical presentation and diagnostic criteria for PTC.
  • Discussion of established medical treatments, including CSF production inhibitors and lumbar punctures.
  • Exploration of surgical CSF diversion and emerging endovascular treatments like venous stenting.

Main Results:

  • Dural sinus stenosis or thrombosis is increasingly recognized as a cause of PTC.
  • Endovascular venous stent placement offers a novel treatment for PTC secondary to venous sinus abnormalities.
  • Comprehensive management requires a multidisciplinary approach.

Conclusions:

  • Pseudotumor cerebri management encompasses medical, surgical, and endovascular strategies.
  • Identifying and treating underlying venous sinus pathology is crucial for refractory PTC cases.
  • Understanding PTC pathophysiology guides effective therapeutic decision-making.

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