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Seilanian Toosi F, Hashemi N, Emadzadeh M, Hassan Nejad E, Payandeh A, Tavakkolizadeh N, Akhondian J, Ashrafzadeh F, Beiraghi Toosi M, Shahmoradi Y, Pourzal M, Kazemi SA, Moodi Ghalibaf A, Beizaei B. The diagnostic value of MRI findings in pediatric idiopathic intracranial hypertension: a case-control study. Childs Nerv Syst 2024; 40:2115-2123. [PMID: 38478069 DOI: 10.1007/s00381-024-06354-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/01/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a rare medical condition in children. Based on the different radiological findings reported in various studies in pediatric IIH, this study was conducted to determine the diagnostic value of MRI findings in diagnosing IIH in children. METHODS In this retrospective study, the medical records of all children aged 1 to 18 years who visited Ghaem Hospital in Mashhad, Iran, between 2012 and 2022 and were diagnosed with IIH were gathered. Forty-nine cases of children with IIH and 48 control cases of children with the first unprovoked seizure with no indications of increased intracranial pressure for comparison were selected. Patient demographic information and MRI findings were extracted. The comparison between different MRI findings in the case and control groups was conducted using statistical tests. RESULTS In the case group, the mean diameter of the subarachnoid space expansion around the optic nerve was 5.96 ± 1.21, compared to 4.79 ± 0.33 in the control group, with statistically significant difference (P < 0.001). All the patients with flattening of the posterior globe or transverse sinus stenosis were in the case group, and the frequency of these findings in the case group was significantly higher than in the control group (P < 0.001). The majority of patients (95.5%) classified under category 3 and 4 of empty sella were part of the case group, and the statistical test results indicated a significant difference between the two groups (P < 0.001). The optic nerve sheath diameter cut-off of 5.35 mm, when used for expansion of the subarachnoid space around the optic nerve, with a sensitivity of 82% and a specificity of 100% in diagnosing IIH. CONCLUSION The most reliable diagnostic indicators for diagnosing IIH in children are perioptic subarachnoid space expansion with high sensitivity, and posterior globe flattening and transverse sinus stenosis with high specificity.
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Affiliation(s)
- Farrokh Seilanian Toosi
- Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Hashemi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Emadzadeh
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Hassan Nejad
- Department of Radiology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Asma Payandeh
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Tavakkolizadeh
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Akhondian
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farah Ashrafzadeh
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehran Beiraghi Toosi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yousef Shahmoradi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - MohammadReza Pourzal
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Amirhossein Kazemi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Behnam Beizaei
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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2
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Nunna R, Tariq F, Jummah F, Bains N, Qureshi AI, Siddiq F. Advances in the Endovascular Management of Cerebrovascular Disease. MISSOURI MEDICINE 2024; 121:127-135. [PMID: 38694595 PMCID: PMC11057869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The field of endovascular neurosurgery has experienced remarkable progress over the last few decades. Endovascular treatments have continued to gain traction as the advancement of technology, technique, and procedural safety has allowed for the expansion of treatment indications of various cerebrovascular pathologies. Interventions such as the coiling of intracranial aneurysms, carotid artery stenting, mechanical thrombectomy in the setting of ischemic stroke, and endovascular embolization of arteriovenous malformations have all seen transformations in their safety and efficacy, expanding the scope of endovascularly treatable conditions and offering new hope to patients who may have otherwise not been candidates for surgical intervention. Despite this notable progress, challenges persist, including complications associated with device deployment and questions regarding long-term outcomes. This article explores the advancements in endovascular neurosurgical techniques, highlighting the impact on patient care, outcomes, and the evolution of traditional surgical methods.
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Affiliation(s)
- Ravi Nunna
- Department of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Farzana Tariq
- Department of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Fareed Jummah
- Department of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Navpreet Bains
- Department of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri-Columbia, Columbia, Missouri
| | - Farhan Siddiq
- Department of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
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3
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Thanki S, Guerrero W, Mokin M. Treatment of Pseudotumor Cerebri (Sinus Stenosis). Neurosurg Clin N Am 2022; 33:207-214. [DOI: 10.1016/j.nec.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Papilledema. Neuroophthalmology 2022. [DOI: 10.1007/978-981-19-4668-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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5
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Bridging the Gap between Ophthalmology and Emergency Medicine in Community-Based Emergency Departments (EDs): A Neuro-Ophthalmology Guide for ED Practitioners. Clin Pract 2021; 11:919-932. [PMID: 34940005 PMCID: PMC8700032 DOI: 10.3390/clinpract11040106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/28/2021] [Accepted: 11/19/2021] [Indexed: 01/13/2023] Open
Abstract
Coordination of care for patients with neuro-ophthalmic disorders can be very challenging in the community emergency department (ED) setting. Unlike university- or tertiary hospital-based EDs, the general ophthalmologist is often not as familiar with neuro-ophthalmology and the examination of neuro-ophthalmology patients in the acute ED setting. Embracing image capturing of the fundus, using a non-mydriatic camera, may be a game-changer for communication between ED physicians, ophthalmologists, and tele-neurologists. Patient care decisions can now be made with photographic documentation that is then conveyed through HIPAA-compliant messaging with accurate and useful information with both ease and convenience. Likewise, external photos of the anterior segment and motility are also helpful. Finally, establishing clinical and imaging guidelines for common neuro-ophthalmic disorders can help facilitate complete and appropriate evaluation and treatment.
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6
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A Case of Persistent Diplopia Postconcussion in a 34-Yr-Old Woman. Am J Phys Med Rehabil 2021; 100:e180-e182. [PMID: 33871430 DOI: 10.1097/phm.0000000000001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Horev A, Lorber D, Vardi-Dvash N, Zlotnik Y, Biederko R, Ifergane G, Shelef I, Zvenigorodsky V, Horev A. A Comparison Between Pressure Wire and Microcatheter Measurements for Evaluating the Cerebral Venous Pressure Gradient. Front Neurol 2021; 12:711870. [PMID: 34721256 PMCID: PMC8554017 DOI: 10.3389/fneur.2021.711870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: A pressure gradient of over 8 mm Hg across the stenosis (usually located in the transverse-sigmoid junction) is one of the criteria for cerebral venous stenting in idiopathic intracranial hypertension (IIH) patients. The possible inaccuracy of the traditional microcatheter-based pressure measurements has been discussed in previous studies. In the cardiology field, a dual-sensor pressure wire is routinely used for the evaluation of stenotic lesions. Using a pressure wire for cerebral vasculature was previously discussed in a small case series and case reports. In this study, we compared venous pressure measurements obtained using both a microcatheter and a pressure wire in patients who were candidates for stenting. Methods: A retrospective study was conducted, comparing the two methods of pressure measurements in 26 patients with venous stenosis. Altogether, 120 measurements were performed using both methods. Demographic characteristics, medical history, procedural details, medications, indications for the procedure, and complications were collected from the patient charts. Results: Based on an 8-mm Hg pressure gradient cutoff indication, 19 patients were found eligible to go through unilateral venous stenting based on catheter measurements alone. The wire results corroborated the catheter results in detecting all cases indicated for a stent. This finding implies a sensitivity equal to 100% for the wire measurements. There were no wire-related complications, demonstrating its safety. Conclusions: We conclude that the pressure wire is as safe as the microcatheter and can identify cases requiring intervention. A larger-scale study is needed to assess the measurement accuracy of the pressure wire in brain vasculature.
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Affiliation(s)
- Anat Horev
- Neurology Department, Soroka University Medical Center, Beersheba, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Dana Lorber
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Noa Vardi-Dvash
- Neurology Department, Soroka University Medical Center, Beersheba, Israel
| | - Yair Zlotnik
- Neurology Department, Soroka University Medical Center, Beersheba, Israel
| | - Ron Biederko
- Clinical Research Center, Soroka University Medical Center, Beersheba, Israel
| | - Gal Ifergane
- Neurology Department, Soroka University Medical Center, Beersheba, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Ilan Shelef
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.,Radiology Department, Soroka University Medical Center, Beersheba, Israel
| | | | - Amir Horev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.,Pediatric Division, Soroka University Medical Center, Beersheba, Israel
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8
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Uesugi S, Karukaya T, Nakayama H. The Case of a Patient with Idiopathic Intracranial Hypertension Who Required Additional Stenting for Stent-Adjacent Stenosis. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:211-217. [PMID: 37502447 PMCID: PMC10370996 DOI: 10.5797/jnet.cr.2021-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/08/2021] [Indexed: 07/29/2023]
Abstract
Objective We report the case of a patient with recurred idiopathic intracranial hypertension (IIH) with transverse sinus (TS) stenosis after initial stenting, which was treated with additional stent placed in tandem to the secondarily occurred stent-adjacent stenosis (SAS). Case Presentation A 41-year-old woman complained of reduced visual acuity and blurred vision, and presented with papilledema. Lumbar puncture revealed an opening pressure of 36 cmH2O. MRI revealed no space-occupying lesions, and the patient was diagnosed with IIH based on the modified Dandy criteria. MR venography revealed stenosis in the right and hypoplastic left TS. The patient complained of headache and neck pain after each lumbar puncture for examination. Venous sinus stenting (VSS) was performed in the right TS. One month after stenting, follow-up angiography revealed stenosis in the remaining parts of TS. Five months after stenting, IIH recurred, and SAS was detected on angiography. An additional stenting procedure was performed. Three months after the second treatment, her symptoms disappeared and cerebrospinal fluid pressure was normalized. Conclusion Patients with post-VSS recurrent IIH may develop restenosis in the remaining parts of TS at variable progression speeds. In this case, angiography revealed gradually advancing stenosis that seemed to form SAS at the time of recurrence. If the initial VSS is effective for IIH, SAS can also be treated effectively and less invasively with a second stent placement covering the entire TS length.
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Affiliation(s)
- Seiji Uesugi
- Department of Neurosurgery, Oita San-ai Medical Center, Oita, Oita, Japan
| | - Takashi Karukaya
- Department of Neurosurgery, Oita San-ai Medical Center, Oita, Oita, Japan
| | - Hisato Nakayama
- Department of Neurosurgery, Oita San-ai Medical Center, Oita, Oita, Japan
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Essibayi MA, Oushy SH, Lanzino G, Brinjikji W. Venous Causes of Pulsatile Tinnitus: Clinical Presentation, Clinical and Radiographic Evaluation, Pathogenesis, and Endovascular Treatments: A Literature Review. Neurosurgery 2021; 89:760-768. [PMID: 34392338 DOI: 10.1093/neuros/nyab299] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
Tinnitus is an abnormal perception of a sound without external stimulation. Venous pulsatile tinnitus (VPT) is a specific form of tinnitus characterized by an objective and often subjective bruit that occurs as a result of localized venous abnormalities. Clinical evaluation relies on sound quality, duration, and precipitating factors. Idiopathic intracranial hypertension (IIH) and transverse sinus stenosis (TSS) are among the most common causes of VPT. Other causes include sigmoid sinus wall abnormalities (SSWAs), jugular vein anomalies (JVAs), and emissary veins anomalies. These anomalies can be detected on magnetic resonance imaging, magnetic resonance angiography/magnetic resonance venography, and high-resolution temporal bone computed tomography. The pathogenesis behind the VPT includes turbulent blood flow as a result of luminal stenosis or abnormal dilation, amplification of internal sound due to temporal bone defects, and abnormal position of the venous sinus system structures adjacent to the bony structures of the auditive apparatus. Based on these theories, different interventional treatment modalities can be applied to treat the underlying causes. Endovascular treatments have shown high efficacy and safety among those treatments which include stenting of the lateral sinus stenosis in IIH and TSS, coiling of the SSWA and JVA, and embolization of emissary veins anomalies. Further studies are needed to understand the natural history of these anomalies and the efficacy of treatments of VPT, which-unlike other types of tinnitus-can be cured with proper treatment.
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Affiliation(s)
| | - Soliman H Oushy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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10
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Veiga-Canuto D, Carreres-Polo J. Role of imaging in pseudotumor cerebri syndrome. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Veiga-Canuto D, Carreres-Polo J. Papel de la radiología en el síndrome de pseudotumor cerebral. RADIOLOGIA 2020; 62:400-410. [DOI: 10.1016/j.rx.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/26/2020] [Accepted: 05/15/2020] [Indexed: 10/23/2022]
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12
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Yan F, Rajah G, Ding Y, Hua Y, Zhang H, Jiao L, Li G, Ren M, Meng R, Lin F, Ji X. Safety and efficacy of intravascular ultrasound as an adjunct to stenting for cerebral venous sinus stenosis-induced idiopathic intracranial hypertension: a pilot study. J Neurosurg 2020; 132:749-754. [PMID: 30835685 DOI: 10.3171/2018.11.jns181885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 11/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Symptomatic intracranial hypertension can be caused by cerebral venous sinus stenosis (CVSS) and cerebral venous sinus thrombotic (CVST) stenosis, which is usually found in some patients with idiopathic intracranial hypertension (IIH). Recently, at the authors' center, they utilized intravascular ultrasound (IVUS) as an adjunct to conventional venoplasty or stenting to facilitate diagnosis and accurate stent placement in CVSS. METHODS The authors designed a retrospective review of their prospective database of patients who underwent IVUS-guided venous sinus stenting between April 2016 and February 2017. Clinical, radiological, and ophthalmological information was recorded and analyzed. IVUS was performed in 12 patients with IIH (9 with nonthrombotic CVSS, 3 with secondary stenosis combined with CVST) during venoplasty through venous access. The IVUS catheter was used from a proximal location to the site of stenosis. Post-stenting follow-up, including symptomatic improvement, stent patency, and adjacent-site stenosis, was assessed at 1 year. RESULTS Thirteen stenotic cerebral sinuses in 12 patients were corrected using IVUS-guided stenting. No technical or neurological complications were encountered. The IVUS images were excellent for the diagnosis of the stenosis, and intraluminal thrombi were clearly visualized by using IVUS in 3 (25%) of the 12 patients. A giant arachnoid granulation was demonstrated in 1 (8.3%) of the 12 patients. Intravenous compartments or septations (2 of 12, 16.7%) and vessel wall thickening (6 of 12, 50%) were also noted. At 1-year follow-up, 10 of 12 patients were clinically symptom-free in our series. CONCLUSIONS IVUS is a promising tool with the potential to improve the diagnostic accuracy in IIH, aiding in identification of the types of intracranial venous stenosis, assisting in stent selection, and guiding stent placement. Further study of the utility of IVUS in venous stenting and venous stenosis pathology is warranted.
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Affiliation(s)
| | - Gary Rajah
- 2Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Yuchuan Ding
- 2Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | | | | | | | | | - Ming Ren
- 4China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China; and
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Greener DL, Akarca D, Durnford AJ, Ewbank F, Buckland GR, Hempenstall J. Idiopathic Intracranial Hypertension: Shunt Failure and the Role of Obesity. World Neurosurg 2020; 137:e83-e88. [PMID: 31954904 DOI: 10.1016/j.wneu.2020.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a chronic condition characterized by raised intracranial pressure in the absence of a known etiology. IIH typically presents in overweight women of childbearing age. Surgical intervention for IIH involves diversion of cerebrospinal fluid, often by the placement of a shunt. Experience suggests higher shunt failure rates in patients with IIH than shunts placed for other etiologies. Here we sought to both establish and compare failure rates for IIH and non-IIH shunts and to examine association with body mass index (BMI). METHODS This study was a single-center retrospective consecutive cohort over a 13-year period. There were 1264 non-IIH patients and 116 patients with IIH included in the study. This was a retrospective analysis of time to shunt failure using Kaplan-Meier methods for IIH and non-IIH shunts. Secondary analysis of BMI, shunt type, and sex on IIH shunt failure was also conducted. RESULTS The median time to failure of the initial IIH shunt was 22.9 months (interquartile range [IQR], 4-55) compared with 57 months (IQR, 12-87) in non-IIH shunts (P < 0.001; 95% confidence interval, 58.6-233.6). In the IIH group, the median shunt survival for BMI above the healthy range (18.5-25 kg/m2) was 18 months relative to 44 months for those with a healthy BMI. CONCLUSIONS Our study suggests that in IIH, relative to hydrocephalus of other causes, shunts have higher failure rates and often require more frequent revisions. Higher shunt failure rates in patients with IIH may be associated with an unhealthy BMI.
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Affiliation(s)
- Daniele L Greener
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Danyal Akarca
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Andrew J Durnford
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom
| | - Frederick Ewbank
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - George R Buckland
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jonathan Hempenstall
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, United Kingdom.
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14
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Kulhari A, He M, Fourcand F, Singh A, Zacharatos H, Mehta S, Kirmani JF. Safety and Clinical Outcomes after Transverse Venous Sinus Stenting for Treatment of Refractory Idiopathic Intracranial Hypertension: Single Center Experience. JOURNAL OF VASCULAR AND INTERVENTIONAL NEUROLOGY 2020; 11:6-12. [PMID: 32071666 PMCID: PMC6998806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure of unknown etiology. Unilateral or bilateral transverse sinus (TS) or transverse-sigmoid junction stenosis is present in about 30%-93% of these patients. There is an ongoing debate on whether venous sinus stenosis is the cause of IIH or a result of it. The subset of IIH patients who continue to have clinical deterioration despite maximum medical therapy is termed as "refractory IIH." Traditionally, cerebrospinal fluid diversion surgeries (ventriculoperitoneal shunt and lumboperitoneal shunt) and optic nerve sheath fenestration (ONSF) were the mainstays of treatment for refractory IIH. In the last decade, venous sinus stenting (VSS) has emerged as a safe and effective option for treating refractory IIH patients with venous sinus stenosis. Through this study, we want to share our experience with venous stenting in refractory IIH patients with venous sinus stenosis associated with a significant pressure gradient (≥10 mm Hg). METHODS Retrospective chart review of all the patients diagnosed with refractory IIH who underwent VSS or angioplasty at our comprehensive stroke center from November 2016 to March 2019. RESULTS A total of seven refractory IIH patients underwent VSS or angioplasty within the specified period. The mean age was 39 years. Eighty-five percent of the patients were women (n = 6). The mean body mass index (BMI) was 37 kg/m2. Headache was the most common symptom (85%, n = 6) followed by transient visual obscurations (71%, n = 5) and pulsatile tinnitus (57%; n = 4). All patients had papilledema. Fifty-seven percent of patients (n = 4) had impaired visual field. Mean lumbar opening pressure was 40.6 cm H2O (SD = 9.66; 95% CI = 33.5-47.7). All patients were on maximum doses of acetazolamide ± furosemide. Six patients (85%) had dominant right transverse-sigmoid sinus. Fifty-seven percent of the patients had severe right transverse ± sigmoid sinus stenosis (n = 4) and the rest (43%) had bilateral TS stenosis (n = 3). Prestenting mean trans-stenosis pressure gradient was 18 mm Hg (SD = 6.16; 95% CI = 13.43-22.57). Six patients (85%) were treated with TS stenting and one (15%) with only angioplasty. Poststenting mean trans-stenosis pressure gradient was 4.8 mm Hg (SD = 6.6; 95% CI = -0.1-9.7). All patients were able to come off their medications with significant improvement in neurological and ophthalmological signs and symptoms. No procedure-related complications occurred. CONCLUSION TS stenting ± angioplasty is a safe and effective means of treating refractory IIH with venous sinus stenosis associated with a significant pressure gradient (≥10 mm Hg).
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Affiliation(s)
- Ashish Kulhari
- JFK Stroke and Neurovascular Center, Hackensack Meridian Health—JFK Medical Center, Edison, NJ, USA
| | - Ming He
- JFK Stroke and Neurovascular Center, Hackensack Meridian Health—JFK Medical Center, Edison, NJ, USA
| | - Farah Fourcand
- Medstar Washington Hospital Center, Georgetown University, Washington, DC, USA
| | - Amrinder Singh
- JFK Stroke and Neurovascular Center, Hackensack Meridian Health—JFK Medical Center, Edison, NJ, USA
| | - Haralabos Zacharatos
- JFK Stroke and Neurovascular Center, Hackensack Meridian Health—JFK Medical Center, Edison, NJ, USA
| | - Siddhart Mehta
- JFK Stroke and Neurovascular Center, Hackensack Meridian Health—JFK Medical Center, Edison, NJ, USA
| | - Jawad F. Kirmani
- JFK Stroke and Neurovascular Center, Hackensack Meridian Health—JFK Medical Center, Edison, NJ, USA
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15
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Tafakhori A, Parvizi M, Farzanefar S, Ahmadzadehfar H, Khalaj A, Naseri M, Abbasi M. Clinical use of 99mTc-HMPAO-labeled platelets in cerebral sinus thrombosis imaging. Acta Neurol Belg 2019; 119:549-553. [PMID: 30868466 DOI: 10.1007/s13760-019-01107-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging (MRI) and computed tomography (CT) are not always conclusive for the detection of cerebral venous sinus thrombosis (CVST). 99mTc-HMPAO-labeled platelets may be useful in cases with high clinical suspicion. Three patients with headaches with or without intraparenchymal hemorrhage that were highly suspected to have CVST, despite inconclusive anatomical imaging, were selected for inclusion in the study. Platelets were extracted by two rounds of centrifugation from 49 ml of the patient's whole blood. The platelets were labeled with 99mTc-HMPAO and any unbound 99mTc was removed by centrifugation. The re-suspension of 99mTc-HMPAO-labeled platelets in cell-free plasma was reinjected into the patients. After 2 h, planar and single photon emission computed tomography (SPECT) images of the head were obtained. Extensive clots were detected in all three patients, illustrated in the planar image and even clearer in the SPECT images. We propose that 99mTc-HMPAO-labeled platelet scan is a favorable imaging method for patients suspected to have CVST with inconclusive CT and MRI results.
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16
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Giridharan N, Patel SK, Ojugbeli A, Nouri A, Shirani P, Grossman AW, Cheng J, Zuccarello M, Prestigiacomo CJ. Understanding the complex pathophysiology of idiopathic intracranial hypertension and the evolving role of venous sinus stenting: a comprehensive review of the literature. Neurosurg Focus 2019; 45:E10. [PMID: 29961379 DOI: 10.3171/2018.4.focus18100] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a disease defined by elevated intracranial pressure without established etiology. Although there is now consensus on the definition of the disorder, its complex pathophysiology remains elusive. The most common clinical symptoms of IIH include headache and visual complaints. Many current theories regarding the etiology of IIH focus on increased secretion or decreased absorption of cerebrospinal fluid (CSF) and on cerebral venous outflow obstruction due to venous sinus stenosis. In addition, it has been postulated that obesity plays a role, given its prevalence in this population of patients. Several treatments, including optic nerve sheath fenestration, CSF diversion with ventriculoperitoneal or lumboperitoneal shunts, and more recently venous sinus stenting, have been described for medically refractory IIH. Despite the availability of these treatments, no guidelines or standard management algorithms exist for the treatment of this disorder. In this paper, the authors provide a review of the literature on IIH, its clinical presentation, pathophysiology, and evidence supporting treatment strategies, with a specific focus on the role of venous sinus stenting.
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Affiliation(s)
| | | | | | | | - Peyman Shirani
- Departments of1Neurosurgery and.,2Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Aaron W Grossman
- Departments of1Neurosurgery and.,2Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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McDougall CM, Ban VS, Beecher J, Pride L, Welch BG. Fifty shades of gradients: does the pressure gradient in venous sinus stenting for idiopathic intracranial hypertension matter? A systematic review. J Neurosurg 2019; 130:999-1005. [PMID: 29498569 DOI: 10.3171/2017.8.jns17459] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 08/21/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The role of venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) is not well understood. The aim of this systematic review is to attempt to identify subsets of patients with IIH who will benefit from VSS based on the pressure gradients of their venous sinus stenosis. METHODS MEDLINE/PubMed was searched for studies reporting venous pressure gradients across the stenotic segment of the venous sinus, pre- and post-stent pressure gradients, and clinical outcomes after VSS. Findings are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS From 32 eligible studies, a total of 186 patients were included in the analysis. Patients who had favorable outcomes had higher mean pressure gradients (22.8 ± 11.5 mm Hg vs 17.4 ± 8.0 mm Hg, p = 0.033) and higher changes in pressure gradients after stent placement (19.4 ± 10.0 mm Hg vs 12.0 ± 6.0 mm Hg, p = 0.006) compared with those with unfavorable outcomes. The post-stent pressure gradients between the 2 groups were not significantly different (2.8 ± 4.0 mm Hg vs 2.7 ± 2.0 mm Hg, p = 0.934). In a multivariate stepwise logistic regression controlling for age, sex, body mass index, CSF opening pressure, pre-stent pressure gradient, and post-stent pressure gradient, the change in pressure gradient with stent placement was found to be an independent predictor of favorable outcome (p = 0.028). Using a pressure gradient of 21 as a cutoff, 81/86 (94.2%) of patients with a gradient > 21 achieved favorable outcomes, compared with 82/100 (82.0%) of patients with a gradient ≤ 21 (p = 0.022). CONCLUSIONS There appears to be a relationship between the pressure gradient of venous sinus stenosis and the success of VSS in IIH. A randomized controlled trial would help elucidate this relationship and potentially guide patient selection.
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Affiliation(s)
- Cameron M McDougall
- Departments of1Radiology and
- 2Neurosurgery, University of Texas Southwestern, Dallas, Texas
| | - Vin Shen Ban
- 2Neurosurgery, University of Texas Southwestern, Dallas, Texas
| | - Jeffrey Beecher
- 2Neurosurgery, University of Texas Southwestern, Dallas, Texas
| | | | - Babu G Welch
- Departments of1Radiology and
- 2Neurosurgery, University of Texas Southwestern, Dallas, Texas
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Chen L, Jiang Y, Hu F, Zhou M, Li G, Wang Y, He L, Zheng H. Femoral-Long Sheath-Reshape-Anchoring-Stenting (FLRAS) Technique in Venous Sinus Stenting for Idiopathic Intracranial Hypertension. World Neurosurg 2018; 124:S1878-8750(18)32875-4. [PMID: 30590216 DOI: 10.1016/j.wneu.2018.12.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the novel Femoral-Long Sheath-Reshape-Anchoring-Stenting (FLRAS) technique (developed by Dr. Hongbo Zheng) for venous sinus stenting in patients with idiopathic intracranial hypertension. DESIGN Retrospective, single center study. MATERIALS AND METHODS We comparatively analyzed clinical and imaging data from consecutive patients with idiopathic intracranial hypertension who underwent venous sinus stenting using either traditional technique from June 2013 to May 2015 or FLRAS technique (described in this mansucript) from May 2015 to May 2018. RESULTS A total of 20 patients (mean age, 36.7 [range, 17-50] years; 15 women) were enrolled in the study. In FLRAS group (n=12) vs. traditional stenting group (n=8): mean procedure duration was significantly shorter (48.3 min vs. 92.5 min, P <0.001), and procedure success rate was numerically higher (100% vs. 87.5%, P>0.05), with no vs. 2 complications, respectively. CONCLUSIONS Use of FLRAS technique for venous sinus stenting in patients with idiopathic intracranial hypertension appeared to yield favorable outcomes relative to use of the traditional stenting technique. A large, multicenter, randomized study is warranted to confirm these findings.
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Affiliation(s)
- Lizhang Chen
- West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 611137, China
| | - Yi Jiang
- West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 611137, China
| | - Fayun Hu
- West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 611137, China
| | - Muke Zhou
- West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 611137, China
| | - Guangzong Li
- Central Hospital of Panzhihua City, Panzhihua, Sichuan Province, 617000, China
| | - Yan Wang
- Chengdu Fifth People's Hospital, Chengdu, Sichuan Province, 611130, China
| | - Li He
- West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 611137, China
| | - Hongbo Zheng
- West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, 611137, China.
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Leishangthem L, SirDeshpande P, Dua D, Satti SR. Dural venous sinus stenting for idiopathic intracranial hypertension: An updated review. J Neuroradiol 2018; 46:148-154. [PMID: 30219337 DOI: 10.1016/j.neurad.2018.09.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/12/2018] [Accepted: 09/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dural venous sinus stenting (DVSS) is an accepted treatment option in selected patients with medically refractory idiopathic intracranial hypertension and obstructive venous outflow physiology prior to cerebrospinal flow diversion (CSFD) surgery. There are no randomized controlled studies focusing on outcomes and complication rates for dural venous sinus stenting. PURPOSE We present the largest comprehensive meta-analysis on DVSS for idiopathic intracranial hypertension (IIH) focusing on success rates, complications, and re-stenting rates to date. We also present a simplified approach to direct retrograde internal jugular vein (IJ) access for DVSS that allows for expedited procedures. MATERIALS AND METHODS We performed a retrospective electronic PubMed query of all peer-reviewed articles in the last 15 years between 2003 to 2018. We included all patients who underwent dural venous sinus stenting for a medically refractive IIH and excluded articles without sufficient data on outcomes, complication rates and re-stenting rates. We also evaluated and compared outcomes in patients undergoing direct retrograde IJ access DVSS to traditional transfemoral vein access. RESULTS A total of 29 papers and 410 patients who underwent DVSS met criteria for inclusion. DVSS was associated with high technical success [99.5%], low rates of repeated procedure [10%], and low major complication rates [1.5%]. CONCLUSION Our retrospective comprehensive review of DVSS for medically refractory IIH suggests that stenting in appropriately chosen patients is associated with low complication rates, high technical success, and low repeat procedure rates.
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Affiliation(s)
- Lakshmi Leishangthem
- Department of Neurology, Albert Einstein medical center, 5401 Old York Road, 19141 Philadelphia, PA, USA.
| | - Pooja SirDeshpande
- Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA.
| | - Dharti Dua
- Department of Neurology, Ohio State University, Columbus, OH, USA.
| | - Sudhakar R Satti
- Department of Neuro Interventional Surgery, Christiana Care Hospital, Newark, Delaware, USA.
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Sharma N, Hitti FL, Liu G, Grady MS. Pseudotumor cerebri comorbid with meningioma: A review and case series. Surg Neurol Int 2018; 9:130. [PMID: 30105128 PMCID: PMC6044140 DOI: 10.4103/sni.sni_484_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background Pseudotumor cerebri (PTC), which has a prevalence in the general population of 1 to 2 out of 100,000, presents with raised intracranial pressure (ICP) but generally lacks a space occupying lesion. Case Description Patient 1 is a 32-year-old woman with a history of multiple meningiomas. Upon presentation to our institution, her clinical exam was notable for a right sixth nerve palsy. An integrated diagnosis of PTC was made and shunting for the cerebrospinal fluid (CSF) diversion was recommended. Approximately 6 weeks after surgery, the patient exhibited complete symptom resolution and discontinued all medications. Patient 2 is a 40-year-old woman with history of meningioma causing partial obstruction of the right transverse sigmoid sinus. She agreed to undergo surgery for the left ventriculoperitoneal (VP) shunt placement, for management of her PTC. Postoperatively, the patient reported that her vision significantly improved. Patient 3 is a 49-year-old woman with history of meningioma who presented with left visual field cut. A right frontal VP shunt was recommended for the treatment of PTC. Postoperatively, the patient reported significant symptom improvement and resolution of visual complaints. Conclusion This case series demonstrates that it is important to keep PTC in the differential diagnosis even when mass lesions such as meningiomas are discovered. Although PTC, as the name indicates, is classically diagnosed in patients without intracranial tumors, it is critical that this not be used as an absolute exclusion criterion. Finally, this case series supports the hypothesis that venous obstruction can result in PTC.
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Affiliation(s)
- Nikhil Sharma
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Frederick L Hitti
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Grant Liu
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - M Sean Grady
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
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Anzeljc AJ, Frias P, Hayek BR, Canter Weiner N, Wojno TH, Kim HJ. A 15-year review of secondary and tertiary optic nerve sheath fenestration for idiopathic intracranial hypertension. Orbit 2018; 37:266-272. [PMID: 29313398 DOI: 10.1080/01676830.2017.1423337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Optic nerve sheath fenestration (ONSF) is a common surgical option for patients with idiopathic intracranial hypertension (IIH) with vision loss refractory to medical management. Little is known about the visual benefit of repeated ONSF. The authors aimed to assess the efficacy of secondary and tertiary ONSF in patients with IIH. METHODS A retrospective chart review was performed on all patients with repeat ONSF for IIH at Emory University from 1999 to 2016. Primary outcome measures included visual acuity, optic nerve head findings, and visual field results. RESULTS A total of nine eyes in seven patients (five females and two males) with repeat ONSF were identified. Two of the seven patients had repeat ONSF in both eyes, while the remaining five patients had only one eye repeated. Five of seven patients (five eyes) improved or remained stable after the secondary ONSF. Two patients (three eyes) continued to worsen despite the secondary fenestration surgery and underwent tertiary ONSF at an average of 13.2 months (SD 5.5 months) after the failed secondary ONSF. Both patients that underwent the tertiary fenestration showed improvement. Six of the patients had either improvement or stability in their clinical findings at their last documented follow-up, but one continued to worsen despite intervention. CONCLUSIONS This study suggests that secondary and tertiary nerve sheath fenestration is a viable management option for patients with progressive vision loss from IIH. Repeat ONSFs do not appear to have increased complication or failure rates compared to prior documented studies regarding primary fenestrations.
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Affiliation(s)
- Andrew J Anzeljc
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
| | - Patrick Frias
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
| | - Brent R Hayek
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
| | | | - Ted H Wojno
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
| | - H Joon Kim
- a Department of Ophthalmology , Emory University School of Medicine , Atlanta , GA , USA
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Stevens SM, Rizk HG, Golnik K, Andaluz N, Samy RN, Meyer TA, Lambert PR. Idiopathic intracranial hypertension: Contemporary review and implications for the otolaryngologist. Laryngoscope 2017; 128:248-256. [PMID: 28349571 DOI: 10.1002/lary.26581] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES 1) Review controversies pertaining to the pathophysiology, diagnosis, and treatment of idiopathic intracranial hypertension. 2) Discuss the evolving role of otolaryngologists in managing this disease and related disorders. DATA SOURCES Primary literature review, Centers for Disease Control and Prevention website, International Classification of Headache Disorders, Second Edition. METHODS A comprehensive review of the primary literature was performed from 1990 to 2016 utilizing keywords idiopathic intracranial hypertension, pseudotumor cerebri, benign intracranial hypertension, spontaneous cerebrospinal fluid leak, and encephalocele. Articles were included at the discretion of the authors based on novel and/or historical contributions to the literature. RESULTS The incidence of idiopathic intracranial hypertension is increasing along with the obesity epidemic. Undiagnosed patients may present to otolaryngologists with pulsatile tinnitus, dizziness, sleep apnea, and spontaneous cerebrospinal fluid leaks. Although diagnosis is predicated upon imaging findings and lumbar puncture, radiographic signs including empty sella, optic nerve dilation, and globe flattening may suggest the diagnosis. The most effective intervention is weight loss combined with acetazolamide. Surgery is reserved for severe or refractory symptoms and can be highly morbid. Otolaryngologists are increasingly responsible for managing a number of secondary disorders including cerebrospinal fluid rhinorrhea and otorrhea. Failure to manage intracranial hypertension may lead to adverse surgical outcomes. CONCLUSIONS The knowledge base for idiopathic intracranial hypertension has greatly expanded over the past 25 years. This disease is associated with a number of conditions directly relevant to otolaryngologists. A keen understanding of this disorder and its management may optimize outcomes in a growing number of patients. Laryngoscope, 128:248-256, 2018.
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Affiliation(s)
- Shawn M Stevens
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, U.S.A
| | - Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Karl Golnik
- Department of Ophthalmology, Cincinnati Eye Institute, Cincinnati, Ohio, U.S.A
| | - Norberto Andaluz
- Division of Skull Base Surgery, Mayfield Brain & Spine, Cincinnati, Ohio, U.S.A
| | - Ravi N Samy
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine and Neurosensory Disorders Center at University of Cincinnati Neuroscience Institute, Cincinnati, Ohio, U.S.A
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Paul R Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Kumpe DA, Seinfeld J, Huang X, Mei Q, Case DE, Roark CD, Subramanian PS, Lind KE, Pelak VS, Bennett JL. Dural sinus stenting for idiopathic intracranial hypertension: factors associated with hemodynamic failure and management with extended stenting. J Neurointerv Surg 2016; 9:867-874. [DOI: 10.1136/neurintsurg-2016-012810] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/19/2016] [Indexed: 11/04/2022]
Abstract
BackgroundSome patients undergoing dural sinus stenting for idiopathic intracranial hypertension (IIH) develop clinical and hemodynamic failure (recurrence of the pressure gradient) owing to stent-adjacent stenosis.ObjectiveTo characterize factors associated with hemodynamic failure, and to describe outcomes of patients after repeat stenting.Materials and methodsWe reviewed the initial and follow-up clinical, venographic, and hemodynamic data in 39 patients with IIH treated over 17 years with stenting. Thirty-two had follow-up angiographic and hemodynamic data at 1–99 months (mean 27.6, median 19.5 months). Eight patients were treated with 12 repeat stenting procedures, including extended stenting into the superior sagittal sinus (SSS).ResultsAll patients had an initial successful hemodynamic result with the pressure gradient reduced from 10–43 to 0–7 mm Hg. 10/32 patients (31.3%), all women, developed new stenoses in the transverse sinus or posterior SSS above the stent with a recurrent pressure gradient. 7/9 patients with pure extrinsic stenosis of the transverse-sigmoid junction pre-stenting developed new stenoses and hemodynamic failure. All patients with hemodynamic failure who were restented had early and mid-term documented hemodynamic success at 1.7–50 months. They were free from papilledema at 3.8–50 months after the last restenting, and 11.5–99.5 months after initial stent placement (mean 45.3, median 38.5 months).ConclusionsPure extrinsic compression of the transverse-sigmoid junction and female gender were strongly associated with hemodynamic failure. Eight patients with hemodynamic failure who were restented had successful control of papilledema, including 4/4 who had extended stenting into the SSS.
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Gold DR, Zee DS. Neuro-ophthalmology and neuro-otology update. J Neurol 2015; 262:2786-92. [DOI: 10.1007/s00415-015-7825-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 12/19/2022]
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Highlights in neuro-ophthalmology. Saudi J Ophthalmol 2015; 29:1-2. [DOI: 10.1016/j.sjopt.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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