Venous Sinus Stenting Outcomes in Patients with Papilledema from Secondary Causes of Elevated Intracranial Pressure

Venous sinus stenting (VSS) has recently emerged as a promising intervention in patients with idiopathic intracranial hypertension (IIH) who fail medical therapy. Less is known on outcomes of VSS to manage papilledema from secondary causes of increased intracranial pressures (ICP), such as venous sinus thrombosis. A retrospective cohort study was conducted to evaluate the outcomes of VSS for four patients with papilledema from secondary causes of elevated ICP. A subset of 25 consecutive IIH patients with equivalent degrees of papilledema who underwent VSS served as a comparison group. Of the four patients with secondary causes of papilledema, three had increased ICP due to venous sinus thrombosis and one following surgical treatment of a spinal CSF-venous fistula. The median papilledema grade in patients with secondary causes of elevated ICP was 3.75 (range 3-4) at baseline, with only one (25%) having a significant sustained improvement in papilledema after VSS (overall post-stent median papilledema grade 2.5, range 0-3.5). In comparison, all 25 patients with IIH and grade ≥3 papilledema at baseline (median 4, range 3-5) had improvement of papilledema at least to grade 1 (median 1, range 0-1) at 3-month follow-up (p=0.003 for secondary causes vs IIH). Three (75%) patients with secondary causes of elevated ICP and four (16%) IIH patients required additional procedures for residual raised intracranial pressure after initial VSS (p=0.034). This study suggests that secondary causes of raised ICP may respond less to VSS than IIH patients with similar degrees of papilledema.