1
|
Gorjian M, Andrada JE, Sitko KR, Sorte DE, Taylor CL, Eliyas JK, Carlson AP. Dural venous sinus stenting technique for idiopathic intracranial hypertension in patients with tortuous venous anatomy. Neurosurg Rev 2023; 46:177. [PMID: 37462792 DOI: 10.1007/s10143-023-02087-0] [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: 05/12/2023] [Revised: 06/27/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
Venous sinus stenting (VSS) for medically refractory idiopathic intracranial hypertension (IIH) is emerging as a safe and effective alternative to shunting. However, stent navigation past the jugular bulb with commonly used carotid stenting systems via femoral access in cases with tortuous venous anatomy can present a challenge, leading to procedural failure. We present a technical refinement using a cervical access and peripheral vascular stent with a more stable 0.035-in. delivery platform as an alternative to the traditional approach to simplify the procedure and overcome the technical difficulties in cases with tortuous venous anatomy. Our institutional database for patients who had IIH and undergone VSS using the peripheral vascular stent between 2013 and 2023 was retrospectively reviewed. Data on 36 patients (33 women, 3 men, mean age 32 years) was collected. VSS was technically successful in all patients (100%) without major complications or thrombosis. There was one case of minor neck cellulitis treated with oral antibiotics. Three patients underwent repeat stenting, and 2 patients had ventriculoperitoneal shunt placement after stenting due to persistent or recurrent symptoms. All patients (100%) had improvement or resolution of papilledema; however, six patients had evidence of optic atrophy and persistent vision loss. Headache was resolved or improved in 91% of patients. In the presence of tortuous venous anatomy, VSS using cervical access and a peripheral vascular stent with a more stable 0.035-in. delivery platform can be considered as a safe and effective alternative approach with shorter procedure time. This approach is particularly advantageous in situations where the procedure is prolonged or high dose of contrast has been administered due to the technical challenges associated with the traditional use of carotid systems via femoral access for stent delivery.
Collapse
Affiliation(s)
| | | | - Kevin R Sitko
- University of New Mexico, Albuquerque, NM, 87131, USA
| | | | | | | | - Andrew P Carlson
- Department of Neurosurgery, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
| |
Collapse
|
2
|
Foska A, Palaiodimou L, Stefanou MI, Alonistiotis D, Bakola E, Papagiannopoulou G, Arvaniti C, Bonakis A, Lachanis S, Tsivgoulis G. Telltale Signs of Idiopathic Intracranial Hypertension With Normal Opening Cerebrospinal Fluid Pressure. Neurohospitalist 2023; 13:103-106. [PMID: 36531847 PMCID: PMC9755610 DOI: 10.1177/19418744221131918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Introduction Idiopathic Intracranial Hypertension (IIH) with normal opening cerebrospinal fluid (CSF) pressure comprises a rare IIH variant. Case Report We report the case of a non-obese Caucasian woman, who presented with asymmetrical papilledema, typical IIH-findings on optic nerve sonography and brain magnetic resonance imaging (MRI), and was diagnosed with IIH despite normal opening CSF pressure. Following treatment with acetazolamide, a complete remission of her symptoms was achieved, accompanied by significant improvement of the fundoscopy findings. Conclusion Although normal opening CSF pressure in IIH patients is rare, clinicians should be aware of this IIH variant and promptly indicate IIH treatment in patients presenting with typical clinical symptoms and neuroimaging findings suggestive of IIH.
Collapse
Affiliation(s)
- Aikaterini Foska
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | - Maria Ioanna Stefanou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | - Dimitrios Alonistiotis
- Second Department of Ophthalmology, University of Athens Medical School, “Attikon” University General Hospital, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | - Georgia Papagiannopoulou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | - Chrysa Arvaniti
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | - Anastasios Bonakis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | - Stefanos Lachanis
- Department of Radiolody, Iatropolis Magnetic Resonance Diagnostic Centre, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
3
|
Optic disc edema as a sole manifestation of anti-GQ1b antibody syndrome. J Neurol 2021; 268:2263-2266. [PMID: 33715026 DOI: 10.1007/s00415-021-10518-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
|
4
|
Aghsaei Fard M. Idiopathic Intracranial Hypertension with Normal Cerebrospinal Fluid Pressure. J Ophthalmic Vis Res 2019; 14:532-533. [PMID: 31875113 PMCID: PMC6825698 DOI: 10.18502/jovr.v14i4.5475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/01/2019] [Indexed: 11/24/2022] Open
Abstract
This is a Letter to the Editor and does not have an abstract.
Collapse
Affiliation(s)
- Masoud Aghsaei Fard
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Pal A, Sengupta P, Biswas D, Sen C, Mukherjee A, Pal S. Pattern of Idiopathic Intracranial Hypertension in Indian Population. Ann Indian Acad Neurol 2019; 22:47-51. [PMID: 30692759 PMCID: PMC6327693 DOI: 10.4103/aian.aian_116_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective To evaluate the clinical and demographic profile, laboratory parameters and outcomes of Idiopathic Intracranial hypertension (IIH) patients from Indian subpopulation. Materials and method We did a prospective study on patients who fulfilled the revised diagnostic criteria for Primary pseudotumor cerebri syndrome in adults and children, proposed by Friedman et al in 2013. All patients were examined for BMI, papilloedema, extraocular muscle movement, opening CSF pressure and underwent MRI, MR venography of brain and perimetry. Patients were followed up for a minimum period of 6 months, upto 2 years, with the outcomes monitored being visual acuity, visual field, headache, diplopia and optic disc changes. Results We evaluated 33 patients (31 female and 2 male). 25 patients had BMI less than 25. Commonest clinical presentation was headache. 7 patients showed normal CSF opening pressure. The most common MRI finding was flattening of posterior aspect of globe and was found in 90.90% (30). 25 patients showed either unilateral or bilateral transverse sinus stenosis. Most common finding in perimetry was enlarged blind spot. 4 patients recovered spontaneously and rests were treated with acetazolamide (1gm/day). All showed favorable outcome when followed up. Conclusion Obesity may not be a dominant risk factor for development of IIH in the Indian subcontinent. Non obese IIH have better prognosis and tend to have a good response to medical management alone.
Collapse
Affiliation(s)
- Asutosh Pal
- Department of Neuromedicine, Medical College, Kolkata, West Bengal, India
| | - Prasenjit Sengupta
- Department of Neuromedicine, Medical College, Kolkata, West Bengal, India
| | - Debsadhan Biswas
- Department of Neuromedicine, Medical College, Kolkata, West Bengal, India
| | - Chetana Sen
- Department of Neuromedicine, Medical College, Kolkata, West Bengal, India
| | - Avik Mukherjee
- Department of Neuromedicine, Medical College, Kolkata, West Bengal, India
| | - Sandip Pal
- Department of Neuromedicine, Medical College, Kolkata, West Bengal, India
| |
Collapse
|
6
|
Sajjadi H, Poorsalman H. Previously Diagnosed Leber's Hereditary Optic Neuropathy with Clinical Signs of Idiopathic Intracranial Hypertension Responsive to Acetazolamide Therapy. J Ophthalmic Vis Res 2019; 14:109-113. [PMID: 30820297 PMCID: PMC6388523 DOI: 10.4103/jovr.jovr_85_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To present a case of suspected Leber's hereditary optic neuropathy (LHON) with MRI and OCT findings compatible with pseudotumor cerebri responsive to acetazolamide therapy. Case Report A five-year-old boy referred to our clinic with optic atrophy and low vision was originally diagnosed with LHON. Laboratory tests were negative for LHON, while OCT and MRI were consistent with pseudotumor cerebri. Acetazolamide therapy resulted in dramatic improvement of visual acuity. Conclusion Some cases of previously labeled hereditary optic neuropathies with clinical signs of idiopathic intracranial hypertension could respond to intracranial pressure lowering treatment.
Collapse
Affiliation(s)
- Hamid Sajjadi
- San Jose Eye and Laser Medical Center, Cupertino, California, USA.,Department of Ophthalmology, Acacia Medical Center, Dubai, UAE
| | | |
Collapse
|
7
|
Diffusion tensor imaging of the optic disc in idiopathic intracranial hypertension? Neuroradiology 2018; 61:17-18. [PMID: 30488256 DOI: 10.1007/s00234-018-2144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
|
8
|
Wardly D, Wolford LM, Veerappan V. Idiopathic intracranial hypertension eliminated by counterclockwise maxillomandibular advancement: a case report. Cranio 2016; 35:259-267. [PMID: 27370206 DOI: 10.1080/08869634.2016.1201634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a secondary cause of intracranial hypertension (IH). Decreased jugular venous drainage has been seen in patients with idiopathic IH. CLINICAL PRESENTATION A complex case of a 48-year-old female whose idiopathic IH was put into remission after counterclockwise maxillomandibular advancement (CC-MMA), despite persistence of her OSA. CONCLUSION This case highlights the relationship between OSA and IH and points to the significant morbidity that can result from mild OSA and from what are considered borderline intracranial pressures. This indicates the need for a high index of suspicion for actual underlying pathology that can be surgically corrected when patients manifest symptoms of a somatic syndrome. This is the first report in the medical literature of clinical elimination of IH by CC-MMA. The authors propose that this positive outcome was effected via mandibular advancement producing a decrease in jugular venous resistance, allowing improved absorption of cerebrospinal fluid.
Collapse
Affiliation(s)
- Deborah Wardly
- a Independent, Department of Pediatrics , Las Vegas , NV , USA
| | - Larry M Wolford
- b Departments of Oral and Maxillofacial Surgery and Orthodontics , Texas A & M University Health Science Center, Baylor College of Dentistry , Dallas , TX , USA.,c Departments of Oral and Maxillofacial Surgery and Orthodontics , Baylor University Medical Center , Dallas , TX , USA.,d Private Practice , Dallas , TX , USA
| | - Venkat Veerappan
- e Department of Neurology , Southern Hills Hospital , Las Vegas , NV , USA.,f Department of Neurology , Touro University , Las Vegas , NV , USA
| |
Collapse
|