Dynamic intraoperative changes in intracranial pressure during venous stenting.

Area of Science:

• Neurology
• Neurosurgery
• Vascular Surgery

Background:

• Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure (ICP) without a clear cause.
• Transverse sinus stenosis is increasingly recognized as a contributing factor to IIH, leading to symptoms like vision loss and papilledema.
• Conservative management with acetazolamide may provide only transient relief for some patients.

Purpose of the Study:

• To report a case of successful venous sinus stenting in a patient with IIH and complex transverse sinus stenosis.
• To highlight the utility of intraoperative dynamic ICP monitoring in guiding the intervention.
• To demonstrate the feasibility of treating complex venous sinus stenoses with advanced angioplasty and stenting techniques.

Main Methods:

• A middle-aged female with IIH and progressive vision loss underwent evaluation for bilateral transverse sinus stenosis.
• Initial treatment with acetazolamide was followed by lumbar drainage and venous stenting due to recurrent symptoms and elevated ICP.
• Intraoperative dynamic ICP monitoring guided balloon angioplasty and stent deployment in the left transverse/sigmoid sinus, overcoming challenges of venous tortuosity and limited access.

Main Results:

• Successful balloon angioplasty and stent deployment were achieved despite technical difficulties.
• Post-intervention ICP measurements indicated improvement.
• The procedure resulted in improved clinical outcomes for the patient.

Conclusions:

• Dynamic ICP monitoring is crucial for guiding venous stenting in IIH patients.
• Refined treatment strategies utilizing advanced stenting techniques can effectively manage complex venous sinus stenoses.
• This approach holds promise for improving clinical outcomes in challenging IIH cases.