Neurointervention.  2018 Sep;13(2):138-143. 10.5469/neuroint.2018.00990.

Endovascular Treatment of Idiopathic Intracranial Hypertension with Stenting of the Transverse Sinus Stenosis

• Miyachi S
• Hiramatsu
• Ohnishi H
• Takahashi
• Kuroiwa T

• KMID: 2424065
• DOI: http://doi.org/10.5469/neuroint.2018.00990

Abstract

For many years, the pathophysiology of idiopathic intracranial hypertension (IIH) was interpreted as "secondary intracranial hypertension," and IIH was considered to be caused by brain edema due to obstructive sleep apnea. Another theory proposed cerebrospinal fluid (CSF) absorption impairment due to excessive medication with vitamin A derivatives. Other reports pointed out the importance of obesity, which may cause an impairment of intracranial venous drainage due to elevated right atrial pressure. Patients with medically refractory IIH have traditionally undergone a CSF diversion. Venous outlet impairment on IIH has recently been reported as a causative or contributory cause, and thus focused venoplasty of the stenotic sinus with a stent has emerged as a new treatment strategy. We report the cases of two patients who presented with headache and papilledema with IIH. They successfully underwent stent placement at the stenosis of the transverse sinus and experienced complete resolution of symptoms.

Keyword

Idiopathic intracranial hypertension; Transvers sinus; Stenting

MeSH Terms

Absorption
Atrial Pressure
Brain Edema
Cerebrospinal Fluid
Constriction, Pathologic*
Drainage
Headache
Humans
Obesity
Papilledema
Pseudotumor Cerebri*
Sleep Apnea, Obstructive
Stents*
Vitamin A
Vitamin A

Figure

• 

  Fig. 1. MRI T1 image shows almost normal findings without hydrocephalus of brain swelling (A). MR venogram demonstrates stenosis of the right TS and occlusion of the left sigmoid sinus (B). A right internal cerebral angiogram shows stenosis of the proximal side of the TS (C). After balloon sinusplasty (D), the TS is well dilated (E). An MR venogram taken 1 week later shows the patency of the TS despite remaining mild stenosis (F). The MR venogram taken after the recurrence of symptoms (POD 42) shows restenosis of the TS (G), and a cerebral angiogram showed recurrence of the TS stenosis as well (H). Postoperative angiogram after the deployment of the stent (I) shows the normalized TS (J). The photo of ocular fundus reveals marked improvement of papilledema. Preoperative image (upper) and at the 4-month follow-up (lower) (K). MRI, magnetic resonance imaging; TS, transverse sinus; POD, postoperative day

• 

  Fig. 2. MR venogram shows stenosis of the mid-portion of the right TS and left internal jugular vein (A). Right internal cerebral angiogram demonstrates severe stenosis of the TS (B: antero-posterior [A-P] view, C: lateral view). Angiogram after stenting shows fully dilated TS (D: A-P view, E: lateral view). Follow-up angiogram (lateral view) 1 month later shows no recurrence (F). MR, magnetic resonance; TS, transverse sinus; A-P, antero-posterior.

Reference

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