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Dural Venous Sinus Stenting in Pediatric Refractory Idiopathic Intracranial Hypertension: A Case Series and
Brandon Edelbach1, Fransua Sharafeddin2, Eman Hawy3
1Department of Neurosurgery, Loma Linda University, Loma Linda, California, USA.
Insights
Venous sinus stenting offers a safe and effective minimally invasive treatment for pediatric idiopathic intracranial hypertension (IIH) refractory to medical management. This approach led to significant symptomatic and visual improvements in all treated patients.
Area of Science:
- Neurology
- Pediatric Medicine
- Interventional Radiology
Background:
- Pediatric idiopathic intracranial hypertension (IIH) management is challenging.
- Venous sinus stenting is an established treatment for adult IIH.
- Its use in pediatric IIH requires further investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of venous sinus stenting in pediatric patients with IIH.
- To assess outcomes in children with IIH unresponsive to medical therapy.
Main Methods:
- Retrospective review of three pediatric cases with medically refractory IIH.
- All patients underwent venous sinus stenting.
Main Results:
- Three pediatric patients (ages 12-17) with IIH underwent venous sinus stenting after medical management failure.
- All patients experienced symptomatic and visual improvement at 6-month follow-up.
- No major surgical complications were observed.
Conclusions:
- Venous sinus stenting is a viable and safe treatment option for pediatric IIH.
- This minimally invasive procedure can successfully manage refractory pediatric IIH cases.
Background:
Management of pediatric idiopathic intracranial hypertension (IIH) presents significant challenges. Although venous sinus stenting has emerged as an effective minimally invasive treatment for adult IIH, its efficacy and safety in the pediatric population is not well studied.
Methods:
Three cases of pediatric IIH refractory to medical management and treated with venous sinus stenting were retrospectively reviewed.
Results:
The first case, a 17-year-old girl with a body mass index (BMI) of 57.06 kg/m2, cerebrospinal fluid (CSF) opening pressure of 38 cm H2O, and a pressure gradient of 15 mm Hg across the venous sinus stenosis, presented with bilateral optic disc edema, visual deficits, and a worsening 3-day headache. The second case, a 14-year-old girl with a BMI of 57.06 kg/m2, CSF opening pressure of 28 cm H2O, and a pressure gradient of 12 mm Hg across the venous sinus stenosis presented with bilateral optic disc edema, visual deficits, nausea, and headache. The last case, a 12-year-old girl with a BMI of 30.47 kg/m2, opening pressure of 39.5 cm H2O, and a pressure gradient of 7 mm Hg across the venous sinus stenosis, presented with diplopia, headache, and ataxia. All cases had been managed medically with acetazolamide before venous stenting. All 3 patients demonstrated symptomatic and visual improvement at 6-month follow-up, and there were no major surgical complications noted in these patients.
Conclusions:
Although IIH is difficult to manage in the pediatric population, we report successful implementation of venous sinus stenting in the management of pediatric IIH. There were no major operative complications.
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