Venous sinus stent placement is associated with improvement in volumetric skull base thickness

Venous sinus stenting (VSS) is an established treatment for patients with idiopathic intracranial hypertension (IIH). However, the associated effect of VSS on skull base remodeling has not been described.

We performed a single center retrospective study of adults with symptomatic venous sinus stenosis who underwent VSS. Tegmen (tympani and mastoideum) volume was measured on thin cut cranial CT using semi-automated 3D Slicer segmentation. The primary outcome was the within patient change in tegmen volume before and after VSS. Paired analyses were performed for the overall cohort and right-sided stent subgroups. Multivariable linear regression was used to identify factors associated with bilateral tegmen volume change.

Of 65 patients treated with VSS from 2022 to 2026, 25 met the inclusion criteria. Mean age was 40.4 years, 92.0% were women, and median imaging follow-up was 295 days. Inter-rater reproducibility was excellent for the volumetric analysis on predefined anatomical segmentation boundaries. Four surgically repaired right-sided skull base patients were excluded from the ipsilateral analysis. Significant post-stenting mean tegmen growth was observed: right 146 mm³ (95% CI 118 to 174; n=21; P<0.001), left 145 mm³ (95% CI 114 to 170; n=25; P<0.001), and bilateral total 299 mm³ (95% CI 250 to 348; n=21; P<0.001). In the right-sided stent cohort, both ipsilateral and contralateral tegmen volumes increased significantly. Longer follow-up duration and pulsatile tinnitus were independently associated with bilateral tegmen volume gain.

VSS was associated with a significant bilateral increase in tegmen volume in patients with IIH.