Transverse Sinus Stenting Reverses Medically Refractory Idiopathic Intracranial Hypertension.

Area of Science:

• Neurology
• Ophthalmology
• Interventional Radiology

Background:

• Idiopathic intracranial hypertension (IIH) is a condition characterized by increased intracranial pressure.
• Medically refractory IIH presents challenges in management, often involving visual impairment.

Purpose of the Study:

• To evaluate the ophthalmic indications and efficacy of transverse sinus stenting in adults with medically refractory IIH.
• To assess the safety and long-term outcomes of this endovascular intervention.

Main Methods:

• Retrospective cohort study of 226 IIH patients, identifying 32 who underwent transverse sinus stenting for medically refractory disease.
• Assessment of papilledema via OCT, visual field mean deviation, and correlation with CSF and venous sinus pressures.
• Evaluation of stenting complications and patient outcomes.

Main Results:

• Medically refractory IIH was diagnosed in 18% of the cohort, with 90% showing significant transverse sinus stenosis.
• Transverse sinus stenting eliminated papilledema in 96% of treated patients and allowed 81% to cease acetazolamide.
• The procedure demonstrated a low complication rate (6% requiring further intervention) and a favorable safety profile.

Conclusions:

• Medically refractory IIH is frequently associated with transverse sinus stenosis, making stenting a highly effective treatment.
• Endovascular stenting is a safe and often definitive therapy for IIH, preserving vision by resolving papilledema.
• Transverse sinus stenting represents a minimally invasive surgical option for IIH, comparable to glaucoma surgery.