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Management of idiopathic intracranial hypertension in children utilizing venous sinus stenting
Justin Schwarz1, Ali Al Balushi1, Sri Sundararajan1
1Department of Neurological Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA.
Insights
Venous sinus stenting (VSS) shows promise for pediatric idiopathic intracranial hypertension (IIH) with lateral sinus stenosis (LSS). Most young patients experienced symptom improvement and reduced intracranial pressure after VSS.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Interventional Neuroradiology
Background:
- Venous sinus stenting (VSS) is an established treatment for adult idiopathic intracranial hypertension (IIH) with lateral sinus stenosis (LSS).
- The safety and efficacy of VSS in pediatric patients with IIH remain largely unestablished.
Purpose of the Study:
- To evaluate the efficacy and safety of VSS in pediatric patients diagnosed with IIH and LSS.
- To assess VSS as a treatment option for children with severe or refractory IIH.
Main Methods:
- Retrospective analysis of pediatric patients (≤18 years) with IIH and LSS treated with VSS.
- Patients included had fulminant disease, were refractory to medical management, or intolerant to medications.
Main Results:
- Eight pediatric patients (mean age 13.4 years) underwent VSS for severe headaches, visual disturbances, and papilledema.
- Seven out of eight patients showed improvement in symptoms, papilledema, and cerebrospinal fluid (CSF) opening pressure post-VSS.
- No immediate complications were noted, with a mean follow-up of 21 months; two patients required re-stenting.
Conclusions:
- VSS appears to be a viable treatment option for pediatric patients with IIH and LSS.
- It offers a potential solution for cases refractory to medical management, prior surgeries, or presenting with severe disease.
- Further research is warranted to confirm long-term outcomes and safety in this population.
Background:
Venous sinus stenting (VSS) is an accepted and minimally invasive treatment for adult idiopathic intracranial hypertension (IIH) associated with lateral sinus stenosis (LSS). The efficacy and safety of venous sinus stenting (VSS) in children with IIH has not been established.
Methods:
This is a retrospective analysis of IIH patients 18 years of age or younger with LSS treated with VSS at our institution. Included patients have fulminant disease course or are refractory or intolerant to medical management.
Results:
Eight patients were identified; 4 males and 4 females. Mean age is 13.4 years (range 4-18). All patients had severe headaches, 5 had blurred vision, 3 had diplopia and 3 had pulsatile tinnitus. Papilledema was present in 4 patients. Three patients had prior surgical procedures. Four patients were intolerant to medical management, 3 were refractory and 1 had fulminant course. Cerebral venography demonstrated severe stenosis of the dominant sinus in 6 patients and of bilateral co-dominant sinuses in 2 patients. Six patients had intrinsic stenosis and 2 had extrinsic stenosis. Venous sinus stenting (VSS) resulted in improvement of symptoms, papilledema and normalization of CSF opening pressure in 7 patients. No immediate complications were observed. Mean follow-up period is 21 months (range 6-42). Two patients required re-stenting; one responded well and the other had persistent symptoms and underwent subsequent surgical procedures of CSF diversion, suboccipital decompression and duraplasty which were also ineffective.
Conclusion:
VSS may provide a viable option for pediatric IIH patients who are intolerant to medication, have failed conservative management or prior surgical interventions, or present with fulminant disease.
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