New frontiers in venous sinus stenting: Illustrative cases

Area of Science:

• Neurology
• Neurosurgery
• Ophthalmology

Background:

• Idiopathic intracranial hypertension (IIH) is a rare condition often requiring invasive treatment for severe cases unresponsive to medication.
• Cerebrospinal fluid diversion is a common intervention for medically refractory IIH.
• Variant presentations of IIH pose unique management challenges.

Observation:

• Two patients with severe, variant IIH were treated with venous sinus stenting.
• Case 1: A 65-year-old man with vision loss and cognitive decline due to severe transverse-sigmoid sinus stenosis underwent successful stenting.
• Case 2: A 58-year-old woman with headaches and vision loss secondary to jugular bulb stenosis from a paraganglioma received contralateral venous sinus stenting.

Findings:

• Both patients experienced significant improvement in vision post-procedure.
• The first patient showed cognitive improvement, while the second patient reported resolution of headaches.
• Follow-up examinations at 3 months and 1 month, respectively, confirmed these positive outcomes.

Implications:

• Venous sinus stenting presents a viable and effective treatment option for select patients with severe, variant IIH.
• This approach may offer an alternative to cerebrospinal fluid diversion in specific IIH cases.
• Further research into endovascular techniques for IIH management is warranted.