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Schievelkamp AH, Wägele P, Hattingen E. Arachnoid granulations in idiopathic intracranial hypertension: Do they have an influence? Headache 2024; 64:722-728. [PMID: 38922856 DOI: 10.1111/head.14776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE The aim of this study was to investigate whether the relative narrowing of the dural venous sinuses by arachnoid granulations (AGs) is more pronounced in patients with idiopathic intracranial hypertension (IIH) compared to healthy controls. BACKGROUND IIH is characterized by increased intracranial pressure, which is associated with symptoms such as headache and visual disturbances. The role of cerebral venous drainage obstruction in IIH is the subject of ongoing research. MATERIALS AND METHODS In this retrospective case-control study, 3D contrast-enhanced magnetic resonance images of a cohort of 43 patients with IIH were evaluated for (1) the number of AGs per venous sinus and (2) the diameters of the dural venous sinuses at the site of an AG and at standardized measurement points. In addition, the minimum width of the transverse/sigmoid sinus was measured. All data were compared to the same data from a cohort of 43 control participants. RESULTS Patients with IIH showed less relative sinus narrowing by AG compared to controls (median: 7%, interquartile range [IQR] 10% vs. 11%, IQR 9% in controls; p = 0.009). In patients with IIH, sinus diameter was larger at the site of an AG (70 ± 25 mm2) compared to its diameter at the standardized measurement point (48 ± 23 mm2; p = 0.010). In the superior sagittal sinus (SSS), patients with IIH had smaller AGs (median: 3 mm2, IQR 2 mm2 vs. 5 mm2, IQR 3 mm2 in controls; p = 0.023) while the respective sinus segment was larger (median: 69 mm2; IQR 21 mm2 vs. 52 mm2, IQR 26 mm2 in controls; p = 0.002). The right transverse sinus was narrower in patients with IIH (41 ± 21 mm vs. 57 ± 20 mm in controls; p < 0.001). CONCLUSIONS In contrast to our hypothesis, patients with IIH showed less pronounced relative sinus narrowing by AG compared to controls, especially within the SSS, where AGs were smaller and the corresponding sinus segment wider. Smaller AGs could result in lower cerebrospinal fluid resorption, favoring the development of IIH. Conversely, the smaller AGs could also be a consequence of IIH due to backpressure in the SSS because of the narrower transverse/sigmoid sinus, which widens the SSS and compresses the AG.
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Affiliation(s)
- Arndt-Hendrik Schievelkamp
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Pia Wägele
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University Frankfurt, University Hospital Frankfurt am Main, Frankfurt/Main, Germany
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2
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Toshniwal SS, Kinkar J, Chadha Y, Khurana K, Reddy H, Kadam A, Acharya S. Navigating the Enigma: A Comprehensive Review of Idiopathic Intracranial Hypertension. Cureus 2024; 16:e56256. [PMID: 38623134 PMCID: PMC11016992 DOI: 10.7759/cureus.56256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/16/2024] [Indexed: 04/17/2024] Open
Abstract
An unidentified source of increased intracranial pressure is a hallmark of idiopathic intracranial hypertension (IIH), also referred to as pseudotumor cerebri. It mainly affects young, obese women, yet it can happen to anyone, regardless of age, gender, or weight. IIH presents with symptoms such as headaches, visual disturbances, and pulsatile tinnitus and can lead to severe complications, including vision loss, if left untreated. Diagnosis involves clinical evaluation, neuroimaging, and lumbar puncture, while management options include medical interventions and surgical procedures. This review provides a comprehensive overview of IIH, including its etiology, clinical presentation, epidemiology, complications, management approaches, and challenges. Increased awareness among healthcare professionals, standardized diagnostic criteria, and further research efforts are essential for improving outcomes and quality of life for individuals with IIH.
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Affiliation(s)
- Saket S Toshniwal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Jiwan Kinkar
- Neurology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Nagpur, IND
| | - Yatika Chadha
- Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Kashish Khurana
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Harshitha Reddy
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Abhinav Kadam
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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3
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Assoumane I, Touati M, Adamou H, Lagha N, Baaré I, Sanoussi S, Sidi Said A, Morsli A. Management of Idiopathic Intracranial Hypertension: Experience of a North African Center. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1710107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Abstract
Background The idiopathic intracranial hypertension (IIH) is characterized by elevation of intracranial pressure (ICP) in the absence of intracerebral space occupation or venous sinus thrombosis. It usually occurs in obese young women but is very rare in childhood.
Materials and Methods We conducted a retrospective study in the neurosurgical department of Bab El Oued teaching hospital of Algiers over a period of 8 years from January 2008 to December 2015. We analyzed clinical data of 10 patients with IIH diagnosis, and the surgical technique consisted of an insertion of a lumbo-peritoneal shunt.
Results In our study, 80% were women with sex ratio M/F of 0.25; the mean age was 32 years and 60% of our patients were obese. For most of our patients, the postoperative outcome was marked by the disappearance of the headache immediately, disappearance of strabismus and diplopia in the following week, followed by improvement of visual function.
Conclusion The IIH is predominantly a disease of women in the childbearing age; surgical treatment is a good option for patients who resisted medication or did not tolerate it as well as for ICH fulminous in emergency cases.
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Affiliation(s)
- Ibrahim Assoumane
- Department of Neurosurgery, CHU Bab El Oued, Algiers, Algeria
- Department of Neurosurgery, Maradi Reference Hospital, Niger Republic
| | - Mahdia Touati
- Department of Neurosurgery, CHU Bab El Oued, Algiers, Algeria
| | - Harissou Adamou
- Department of General Surgery, Faculty of Health Sciences, University of Zinder, National Hospital, Zinder, Niger Republic
| | - Nadia Lagha
- Department of Neurosurgery, CHU Bab El Oued, Algiers, Algeria
| | - Ibrahim Baaré
- Department of Ophthalmology, Maradi Reference Hospital, Niger Republic
| | - Samuila Sanoussi
- Department of Neurosurgery, Niamey National Hospital, Niger Republic
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4
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Lenck S, Labeyrie MA, Vallee F, Saint-Maurice JP, Guillonnet A, Bernat AL, Vironneau P, Houdart E. Stent Placement for Disabling Pulsatile Tinnitus Caused by a Lateral Sinus Stenosis: A Retrospective Study. Oper Neurosurg (Hagerstown) 2019; 13:560-565. [PMID: 28922875 DOI: 10.1093/ons/opx026] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 01/30/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Lateral sinus stenosis is a little-known cause for pulsatile tinnitus (PT). In several small series, stenting has been described as an effective treatment for disabling PT linked with this type of stenosis. OBJECTIVES To describe the clinical, radiological, and manometric characteristics of patients treated for disabling PT by lateral sinus stenosis. Assessment of the efficacy of stenting for this indication. METHODS Retrospective study of patients treated for isolated PT by stenting of a lateral sinus stenosis in our institution, between 2009 and 2015. RESULTS Fourteen patients were included in our study. All of them were women. The median age at the onset of symptoms was 39.0 (21.0) years. The median body mass index was 28.5 (7.0) kg/m 2 . Stenting of the lateral sinus led to the disappearance of PT without recurrence in 13 patients. In one patient, stenting did not modify the noise. In this case, another cause of PT was diagnosed after stent placement. CONCLUSION Lateral sinus stenosis is a curable cause of venous PT. Other causes of PT must be ruled out before an endovascular treatment is undertaken, due to the frequent asymptomatic nature of Pacchioni granulations in the lateral sinus. Treatment by stenting is effective in all cases, provided that stenosis underlies the PT.
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Affiliation(s)
- Stéphanie Lenck
- Department of Neuroradiology, Hôpital Lariboisière, Paris, France.,EA 7334 REMES, Université Paris-Diderot, Paris, France
| | - Marc-Antoine Labeyrie
- Department of Neuroradiology, Hôpital Lariboisière, Paris, France.,EA 7334 REMES, Université Paris-Diderot, Paris, France
| | - Fabrice Vallee
- Department of Anesthesiology and Critical Care, Hôpital Lariboisière, Paris, France
| | - Jean-Pierre Saint-Maurice
- Department of Neuroradiology, Hôpital Lariboisière, Paris, France.,EA 7334 REMES, Université Paris-Diderot, Paris, France
| | - Antoine Guillonnet
- Department of Neuroradiology, Hôpital Lariboisière, Paris, France.,EA 7334 REMES, Université Paris-Diderot, Paris, France
| | | | - Pierre Vironneau
- Department of Otolaryngology, Hôpital Lariboisière, Paris, France
| | - Emmanuel Houdart
- Department of Neuroradiology, Hôpital Lariboisière, Paris, France.,EA 7334 REMES, Université Paris-Diderot, Paris, France
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5
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Al-Mufti F, Dodson V, Amuluru K, Walia J, Wajswol E, Nuoman R, Keller IA, Schonfeld S, Roychowdhury S, Gupta G. Neuroendovascular Cerebral Sinus Stenting in Idiopathic Intracranial Hypertension. INTERVENTIONAL NEUROLOGY 2019; 8:164-171. [PMID: 32508898 DOI: 10.1159/000500051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 03/28/2019] [Indexed: 12/18/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a rare, ill-understood disease of significant morbidity. Because the pathophysiology is poorly understood, treatment protocols are not uniform and are directed towards alleviating the most common symptoms: headache and visual loss. In this review, we analyze 25 case series, all of which included IIH patients (n = 408) who were treated with placement of a venous sinus stent. Among 342 patients who had headache, 240 patients (70.2%) had improvement or resolution of headache after the stent insertion. Of the 217 patients documented to have visual problems, visual acuity was improved or stabilized in 161 patients (74.2%). Of the 304 patients with papilledema, 257 showed resolution or improved (84.5%). Of the 124 patients who presented with pulsatile tinnitus, it was resolved in 110 patients (88.7%) after stent placement. Endovascular management of dural sinus stenosis is therefore clinically efficacious in patients with IIH who have failed medical and surgical therapy.
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Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA.,Department of Neurology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA.,Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Vincent Dodson
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Krishna Amuluru
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA.,Department of Neurointerventional Radiology, University of Pittsburgh, Hamot, Erie, Pennsylvania, USA
| | - Jessy Walia
- Department of Neurology, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Ethan Wajswol
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Rolla Nuoman
- Department of Neurology, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Irwin A Keller
- Department of Radiology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Steven Schonfeld
- Department of Radiology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Sudipta Roychowdhury
- Department of Radiology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Gaurav Gupta
- Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
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6
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Bjornson A, Tapply I, Nabbanja E, Lalou AD, Czosnyka M, Czosnyka Z, Muthusamy B, Garnett M. Ventriculo-peritoneal shunting is a safe and effective treatment for idiopathic intracranial hypertension. Br J Neurosurg 2019; 33:62-70. [PMID: 30653369 DOI: 10.1080/02688697.2018.1538478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the outcome of ventriculo-peritoneal shunts as a treatment for idiopathic intracranial hypertension (IIH) Materials and Methods: Retrospective case series of 28 patients with IIH and evidence of raised intracranial pressure (ICP) who underwent shunt insertion. Patients were identified from a prospectively updated operative database. A case-notes review was performed and data on type of shunt, pre- and post-operative symptoms, ophthalmological findings and post-operative complications were recorded. RESULTS All patients had symptoms of IIH that had failed medical management. Twelve patients had previous lumbo-peritoneal shunts and 2 patients had previous venous sinus stents. All patients had evidence of raised ICP as papilloedema and raised CSF pressure on lumbar puncture. Twenty-seven patients received a ventriculo-peritoneal shunt and 1 patient a ventriculo-atrial shunt. Twenty-six patients received Orbis Sigma Valves and 2 patients Strata valves. At follow-up all patients (100%) had improvement/resolution of papilloedema, 93% had improved visual acuity and 84% had improved headaches. Mean time to last follow-up was 15 (range 4-96) months. Complications occurred in 3 patients (11%): 2 patients required revision of their peritoneal catheters and 1 patient had an anti-siphon device inserted. CONCLUSIONS Previous literature reported a ventricular shunt revision rate of 22-42% in the management of IIH. We demonstrate ventriculo-peritoneal shunts to be an effective treatment with a revision rate of 11% compared to the previously reported 22-42%.
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Affiliation(s)
- Anna Bjornson
- a Department of Neurosurgery , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Ian Tapply
- b Department of Ophthalmology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Eva Nabbanja
- a Department of Neurosurgery , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Afrodite-Despina Lalou
- c Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrookes Hospital , Cambridge University , Cambridge , UK
| | - Marek Czosnyka
- c Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrookes Hospital , Cambridge University , Cambridge , UK
| | - Zofia Czosnyka
- c Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrookes Hospital , Cambridge University , Cambridge , UK
| | - Brinda Muthusamy
- b Department of Ophthalmology , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Matthew Garnett
- a Department of Neurosurgery , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
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7
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8
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Diffusion tensor imaging of the optic disc in idiopathic intracranial hypertension. Neuroradiology 2018; 60:1159-1166. [DOI: 10.1007/s00234-018-2078-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022]
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9
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Cranial morcellation decompression for refractory idiopathic intracranial hypertension in children. Childs Nerv Syst 2018; 34:1111-1117. [PMID: 29502207 DOI: 10.1007/s00381-018-3766-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/21/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Primary idiopathic intracranial hypertension (PIIH) in children is rare and has a poorly understood pathophysiology. It is characterized by raised intracranial pressure (ICP) in the absence of an identified brain lesion. Diagnosis is usually confirmed by the measurement of a high cerebrospinal fluid (CSF) opening pressure and exclusion of secondary causes of intracranial hypertension. Refractory PIIH may lead to severe visual impairment. The purpose of this study was to evaluate a cranial morcellation decompression (CMD) technique as a new surgical alternative to stabilize intracranial pressure in PIIH. MATERIALS AND METHODS A literature review was carried out, disclosing only 7 pediatric cases of PIIH treated with surgical skull expansion. In addition, we describe here one case of our own experience treated by CMD. CONCLUSIONS CMD surgery is a safe and effective option to control refractory PIIH in selected patients.
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10
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Lenck S, Vallée F, Labeyrie MA, Touitou V, Saint-Maurice JP, Guillonnet A, Tantot A, Crassard I, Bernat AL, Houdart E. Stenting of the Lateral Sinus in Idiopathic Intracranial Hypertension According to the Type of Stenosis. Neurosurgery 2017; 80:393-400. [PMID: 27218234 DOI: 10.1227/neu.0000000000001261] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the past decade, stenting of lateral sinus stenosis has been used to treat idiopathic intracranial hypertension. Two types of stenoses have been identified: extrinsic and intrinsic. OBJECTIVE The aim of this study was to report the results of our use of this procedure to treat patients with extrinsic or intrinsic stenoses in idiopathic intracranial hypertension. METHODS We retrospectively studied clinical, radiological, and manometric data from patients with idiopathic intracranial hypertension who were treated at our institution between January 2009 and January 2015 by stenting of the lateral sinus. RESULTS Data were studied from 19 women and 2 men. Average body mass index was 29 kg/m 2 , and the median age at stenting was 33 years. Patients with extrinsic stenoses were younger than those with intrinsic stenoses. Transstenotic gradients measured with patients under general anesthesia were lower than those measured with patients under local anesthesia. In all cases, stenting was effective for papilledema and pulsatile tinnitus. Seventeen patients reporting headaches found that they disappeared completely after stenting. Two complications without long-term effects were reported. CONCLUSION Irrespective of the type of stenosis, stenting of lateral sinus stenoses is an effective treatment for intracranial hypertension symptoms. At our institution, this treatment has replaced draining of cerebrospinal fluid when treatment with acetazolamide has proved to be ineffective.
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Affiliation(s)
| | - Fabrice Vallée
- Anes-thesiology and Critical Care, Hôpital Lariboisière, Paris, France
| | | | - Valérie Touitou
- Department of Ophthalmology, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | | | | | - Audrey Tantot
- Anes-thesiology and Critical Care, Hôpital Lariboisière, Paris, France
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11
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Zhou D, Meng R, Zhang X, Guo L, Li S, Wu W, Duan J, Song H, Ding Y, Ji X. Intracranial hypertension induced by internal jugular vein stenosis can be resolved by stenting. Eur J Neurol 2017; 25:365-e13. [PMID: 29114973 DOI: 10.1111/ene.13512] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Idiopathic intracranial hypertension (IIH) is characterized by abnormally elevated intracranial pressure (ICP) without identifiable etiology. Recently, however, a subset of patients with presumed IIH have been found with isolated internal jugular vein (IJV) stenosis in the absence of intracranial abnormalities. METHODS Fifteen consecutive patients were screened from 46 patients suspected as IIH and were finally confirmed as isolated IJV stenosis. The stenotic IJV was corrected with stenting when the trans-stenotic mean pressure gradient (∆MPG) was equal to or higher than 5.44 cmH2 O. Dynamic magnetic resonance venography, computed tomographic venography and digital subtraction angiography of the IJV, ∆MPG, ICP, Headache Impact Test 6 and the Frisén papilledema grade score before and after stenting were compared. RESULTS All the stenotic IJVs were corrected by stenting. ∆MPG decreased and the abnormal collateral veins disappeared or shrank immediately. Headache, tinnitus, papilledema and ICP were significantly ameliorated at 14 ± 3 days of follow-up (all P < 0.01). At 12 ± 5.6 months of outpatient follow-up, headache disappeared in 14 out of 15 patients (93.3%), visual impairments were recovered in 10 of 12 patients (83.3%) and tinnitus resolved in 10 out of 11 patients (90.9%). In 12 out of 15 cases, the Frisén papilledema grade scores declined to 1 (0-2). The stented IJVs in all 15 patients kept to sufficient blood flows on computed tomographic venography follow-up without stenting-related adverse events. CONCLUSIONS Non-thrombotic IJV stenosis may be a potential etiology of IIH. Stenting seems to be a promising option to address the issue of intracranial hypertension from the etiological level, particularly after medical treatment failure.
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Affiliation(s)
- D Zhou
- Departments of Neurology, Neurosurgery, and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - R Meng
- Departments of Neurology, Neurosurgery, and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - X Zhang
- Departments of Neurology, Neurosurgery, and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - L Guo
- Departments of Neurology, Neurosurgery, and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - S Li
- Departments of Neurology, Neurosurgery, and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - W Wu
- Departments of Neurology, Neurosurgery, and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - J Duan
- Departments of Neurology, Neurosurgery, and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - H Song
- Departments of Neurology, Neurosurgery, and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
| | - Y Ding
- Beijing Institute for Brain Disorders, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - X Ji
- Departments of Neurology, Neurosurgery, and Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Beijing, China
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12
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Tarrats L, Hernández G, Busquets JM, Portela JC, Serrano LA, González-Sepúlveda L, Sánchez-Pérez JR. Outcomes of endoscopic optic nerve decompression in patients with idiopathic intracranial hypertension. Int Forum Allergy Rhinol 2017; 7:615-623. [PMID: 28383199 DOI: 10.1002/alr.21927] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 01/22/2017] [Accepted: 01/24/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The conventional treatment for idiopathic intracranial hypertension involves weight loss, steroids, diuretics, and/or serial lumbar punctures; however, if the symptoms persist or worsen, surgical intervention is recommended. Surgical options include cerebrospinal fluid diversion procedures, such as ventriculoperitoneal and lumboperitoneal shunts, and optic nerve decompression with nerve sheath fenestration. The latter can be carried out using an endoscopic approach, but the outcomes of this technique have not been firmly established. METHODS This systematic review examined the outcomes of performing endoscopic optic nerve decompression (EOND) in patients with idiopathic intracranial hypertension (IIH). Six studies were included for a total of 34 patients. RESULTS The patients presented with visual field disturbances (32 of 32 [100%]), visual acuity disruptions (33 of 34 [97.1%]), papilledema (26 of 34 [76.5%]), and persistent headache (30 of 33 [90.1%]). The mean duration of symptoms ranged from 7 to 32 months. Overall, the patients showed post-EOND improvement in signs and symptoms associated with IIH, specifically visual field deficits (93.8%), visual acuity (85.3%), papilledema (81.4%), and headaches (81.8%). Interestingly, 11 cases showed postoperative improvement in their symptoms with bony decompression of the optic canal alone, without nerve sheath fenestration. There were no major adverse events or complications reported with this approach. CONCLUSION EOND appears to be a promising and safe surgical alternative for patients with IIH who fail to respond to medical treatment. Further studies are needed before we can attest to the clinical validity of this procedure.
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Affiliation(s)
- Luisam Tarrats
- Department of Otolaryngology Head & Neck Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Gabriel Hernández
- Department of Otolaryngology Head & Neck Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - José M Busquets
- Department of Otolaryngology Head & Neck Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan C Portela
- Department of Otolaryngology Head & Neck Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Luis A Serrano
- Department of Ophthalmology, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | | | - José R Sánchez-Pérez
- Department of Otolaryngology Head & Neck Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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13
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Jensen RH, Radojicic A, Yri H. The diagnosis and management of idiopathic intracranial hypertension and the associated headache. Ther Adv Neurol Disord 2016; 9:317-26. [PMID: 27366239 PMCID: PMC4916517 DOI: 10.1177/1756285616635987] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a challenging disorder with a rapid increasing incidence due to a close relation to obesity. The onset of symptoms is often insidious and patients may see many different specialists before the IIH diagnosis is settled. A summary of diagnosis, symptoms, headache characteristics and course, as well as existing evidence of treatment strategies is presented and strategies for investigations and management are proposed.
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Affiliation(s)
- Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Denmark
| | | | - Hanne Yri
- Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet-Glostrup, 2600 Glostrup, Denmark
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14
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Xu Z, Li H, Chen G, Li F, Qian S, Chen Q. Idiopathic intracranial hypertension occurred after spinal surgery: report of two rare cases and systematic review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:9-16. [PMID: 27188182 DOI: 10.1007/s00586-016-4578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a relatively rare syndrome of increased intracranial pressure of unknown etiology. It is characterized by cerebrospinal fluid (CSF) opening pressure more than 250 mmH2O, with normal cranial imaging and CSF content. IIH occurred after spinal surgery is extremely rare. METHODS We present two IIH cases occurred after spinal surgery and conduct a systematic review of articles reporting IIH occurred after spinal surgery. RESULTS The first patient underwent a posterior decompression and fixation for cervical fractures. IIH symptoms appeared 3 days postoperatively and gradually resolved with appropriate medication. The second patient underwent posterior spinal fusion with segmental instrumentation for congenital scoliosis. IIH symptoms appeared 5 days postoperatively and the patient died due to the irreversible intracranial hypertension although underwent intensive care and treatment. The literature review revealed that there were only five cases of IIH occurred after spinal surgery reported till date. CONCLUSIONS IIH occurred after spinal surgery is relatively rare; the diagnosis is based upon exclusion of other diseases. IIH should be kept in mind in patients underwent spinal surgery as it could develop into irreversible intracranial hypertension.
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Affiliation(s)
- Zhengkuan Xu
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, China
| | - Hao Li
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, China
| | - Gang Chen
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, China
| | - Fangcai Li
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, China
| | - Shenjun Qian
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, China
| | - Qixin Chen
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, China.
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Chung CY, John S, Luciano MG, Hui FK. Reduction in Syrinx Size and Severity After Venous Sinus Stenting in a Patient With Pseudotumor Cerebri and Chiari Malformation. Oper Neurosurg (Hagerstown) 2016; 12:E197-E201. [DOI: 10.1227/neu.0000000000001211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/28/2015] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Pseudotumor cerebri and Chiari I malformation are found to coexist in a subset of patients. Surgical cranial decompression has been the mainstay of Chiari malformation management, whereas venous sinus stenting has emerged as an effective treatment modality for pseudotumor cerebri. Gaps in our current understanding of cerebrospinal fluid (CSF) circulation and the pathophysiology behind CSF-related disorders present difficulties in the simultaneous management of these conditions. A case is presented of the successful management of both conditions with venous sinus stenting, with sustained improvement in symptoms and structural abnormalities of the Chiari malformation and associated syrinxes.
CLINICAL PRESENTATION
An obese woman in her 20s with a history of occipital headaches who presented with progressively worsening intermittent visual obscurations was diagnosed with pseudotumor cerebri, Chiari I malformation, and associated spinal syrinxes. Magnetic resonance venography demonstrated right transverse sinus narrowing with an elevated pressure gradient. Successful endovascular intervention with venous sinus stenting achieved normalization of the venous sinus pressure gradient and symptomatic improvement. After stenting, the cervical syrinx was observed to have decreased in size, with a decrease in the extent of cerebellar tonsillar herniation and an increase in CSF signal around the cerebellar tonsils.
CONCLUSION
Venous sinus stenting for treatment of concomitant pseudotumor cerebri and Chiari I malformation can be effective in patients demonstrating transverse sinus stenosis.
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Affiliation(s)
- Charlotte Y Chung
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Seby John
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mark G Luciano
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ferdinand K Hui
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol 2016; 15:78-91. [PMID: 26700907 DOI: 10.1016/s1474-4422(15)00298-7] [Citation(s) in RCA: 271] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 09/07/2015] [Accepted: 10/13/2015] [Indexed: 01/10/2023]
Abstract
Idiopathic intracranial hypertension is a disorder characterised by raised intracranial pressure that predominantly affects young, obese women. Pathogenesis has not been fully elucidated, but several causal factors have been proposed. Symptoms can include headaches, visual loss, pulsatile tinnitus, and back and neck pain, but the clinical presentation is highly variable. Although few studies have been done to support evidence-based management, several recent advances have the potential to enhance understanding of the causes of the disease and to guide treatment decisions. Investigators of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) reported beneficial effects of acetazolamide in patients with mild visual loss. Studies have also established weight loss as an effective disease-modifying treatment, and further clinical trials to investigate new treatments are underway. The incidence of idiopathic intracranial hypertension is expected to increase as rates of obesity increase; efforts to reduce diagnostic delays and identify new, effective approaches to treatment will be key to meeting the needs of a growing number of patients.
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Affiliation(s)
- Keira A Markey
- Neurometabolism Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Susan P Mollan
- Neurometabolism Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK; Birmingham Neuro-Ophthalmology Unit, Ophthalmology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Rigmor H Jensen
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Alexandra J Sinclair
- Neurometabolism Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
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Aaron G, Doyle J, Vaphiades MS, Riley KO, Woodworth BA. Increased Intracranial Pressure in Spontaneous CSF Leak Patients Is Not Associated with Papilledema. Otolaryngol Head Neck Surg 2014; 151:1061-6. [DOI: 10.1177/0194599814551122] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Spontaneous cerebrospinal fluid (CSF) leaks typically present in patients with undiagnosed idiopathic intracranial hypertension (IIH) secondary to pressure erosion of the skull base. Despite elevated intracranial pressure (ICP) on lumbar puncture or ventriculostomy, patients with spontaneous CSF leaks rarely complain of visual disturbances. The objective of this study is to correlate the presence of preoperative papilledema with opening ICP in patients undergoing endoscopic repair of spontaneous CSF leaks. Study Design Prospective study. Setting Tertiary hospital. Methods Prospective evaluation of patients with spontaneous CSF leaks was performed over a 1-year period (December 2012 to December 2013). Fundoscopic examination for papilledema was completed preoperatively and CSF pressure measured by lumbar puncture or ventriculostomy intraoperatively. Data regarding demographics, nature of presentation, and body mass index (BMI) were also recorded and compared to a control cohort of IIH patients with papilledema. Results Sixteen patients (average age 52) were evaluated. Obesity was present in 94% of individuals (average BMI = 43, range, 27-65). Papilledema was absent preoperatively in all subjects. Opening pressures via lumbar puncture/ventriculostomy were 27.4 ± 7.7 cmH20. Following 6 hours of clamping, measurements significantly increased to 36 ± 9.6 cmH20 ( P < .001). IIH controls (average age 33, average BMI = 36, range, 21-52) exhibited average ICP (36.2 ± 11.7) identical to postclamp measurements in the spontaneous CSF leak cohort. Conclusions Subjects with spontaneous CSF leaks had postclamping average ICP identical to controls with IIH and papilledema. Such evidence suggests that a CSF leak in this patient population provides sufficient pressure diversion to avoid the development of papilledema.
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Affiliation(s)
- Geoffrey Aaron
- Departments of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer Doyle
- Department of Opthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael S. Vaphiades
- Department of Opthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristen O. Riley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bradford A. Woodworth
- Departments of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Reynolds MM, McGlynn MC, Al-Ameri M, Al-Zubidi N. Management strategies for idiopathic intracranial hypertension. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.928200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Affiliation(s)
- Jonathan C Horton
- Beckman Vision Center, Department of Ophthalmology, University of California, San Francisco2Departments of Neurology and Physiology, University of California, San Francisco
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