Intracranial Access: Dural Venous Sinus Stenting: 2-Dimensional Operative Video

Area of Science:

• Neurology
• Interventional Radiology

Background:

• Idiopathic intracranial hypertension (IIH) is a condition characterized by elevated intracranial pressure.
• Focal venous sinus stenosis is frequently observed in patients with IIH.
• Cerebral venous sinus stenting is an emerging treatment option for selected IIH patients.

Purpose of the Study:

• To present a case of medically refractory IIH with bilateral sinus stenosis treated with cerebral venous sinus stenting.
• To evaluate the safety and efficacy of stenting in managing IIH symptoms and preventing visual deterioration.

Main Methods:

• A 57-year-old woman with refractory IIH underwent awake venous angiogram with pressure monitoring.
• Significant pressure gradient identified on the right side, prompting stenting.
• Left-sided stenosis managed conservatively with observation.

Main Results:

• The patient tolerated the cerebral venous sinus stenting procedure well.
• Post-procedure, the patient reported improvement in headaches at 2-month follow-up.
• Neurological status remained stable, with no visual deterioration.

Conclusions:

• Cerebral venous sinus stenting can be a safe and effective treatment for selected patients with medically refractory IIH and significant venous sinus stenosis.
• Stenting can lead to symptom resolution and prevent further visual decline.
• Conservative management of less severe stenosis may be appropriate in conjunction with stenting for more significant stenosis.