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Research ArticleInterventionalE

Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions

R.M. Ahmed, M. Wilkinson, G.D. Parker, M.J. Thurtell, J. Macdonald, P.J. McCluskey, R. Allan, V. Dunne, M. Hanlon, B.K. Owler and G.M. Halmagyi
American Journal of Neuroradiology September 2011, 32 (8) 1408-1414; DOI: https://doi.org/10.3174/ajnr.A2575
R.M. Ahmed
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M. Wilkinson
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G.D. Parker
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M.J. Thurtell
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J. Macdonald
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P.J. McCluskey
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R. Allan
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V. Dunne
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M. Hanlon
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B.K. Owler
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G.M. Halmagyi
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Abstract

BACKGROUND AND PURPOSE: Transverse sinus stenosis is common in patients with IIH. While the role of transverse sinus stenosis in IIH pathogenesis remains controversial, modeling studies suggest that stent placement within a transverse sinus stenosis with a significant pressure gradient should decrease cerebral venous pressure, improve CSF resorption in the venous system, and thereby reduce intracranial (CSF) pressure, improving the symptoms of IIH and reducing papilledema. We aimed to determine if IIH could be reliably treated by stent placement in transverse sinus stenosis.

MATERIALS AND METHODS: We reviewed the clinical, venographic, and intracranial pressure data before and after stent placement in transverse sinus stenosis in 52 of our own patients with IIH unresponsive to maximum acceptable medical treatment, treated since 2001 and followed between 2 months and 9 years.

RESULTS: Before stent placement, the mean superior sagittal sinus pressure was 34 mm Hg (462 mm H20) with a mean transverse sinus stenosis gradient of 20 mm Hg. The mean lumbar CSF pressure before stent placement was 322 mm H2O. In all 52 patients, stent placement immediately eliminated the TSS pressure gradient, rapidly improved IIH symptoms, and abolished papilledema. In 6 patients, symptom relapse (headache) was associated with increased venous pressure and recurrent stenosis adjacent to the previous stent. In these cases, placement of another stent again removed the transverse sinus stenosis pressure gradient and improved symptoms. Of the 52 patients, 49 have been cured of all IIH symptoms.

CONCLUSIONS: These findings indicate a role for transverse sinus stent placement in the management of selected patients with IIH.

Abbreviations

ATECO
autotriggered elliptic centric-ordered
IIH
idiopathic intracranial hypertension
LP
lumbar puncture
MRV
MR venography
pCO2
partial pressure of carbon dioxide
TSS
transverse sinus stenosis
  • © 2011 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 32 (8)
American Journal of Neuroradiology
Vol. 32, Issue 8
1 Sep 2011
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Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions
R.M. Ahmed, M. Wilkinson, G.D. Parker, M.J. Thurtell, J. Macdonald, P.J. McCluskey, R. Allan, V. Dunne, M. Hanlon, B.K. Owler, G.M. Halmagyi
American Journal of Neuroradiology Sep 2011, 32 (8) 1408-1414; DOI: 10.3174/ajnr.A2575

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Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions
R.M. Ahmed, M. Wilkinson, G.D. Parker, M.J. Thurtell, J. Macdonald, P.J. McCluskey, R. Allan, V. Dunne, M. Hanlon, B.K. Owler, G.M. Halmagyi
American Journal of Neuroradiology Sep 2011, 32 (8) 1408-1414; DOI: 10.3174/ajnr.A2575
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  • Predictors for venous sinus stent retreatment in patients with idiopathic intracranial hypertension
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  • Dural sinus stenting for idiopathic intracranial hypertension: factors associated with hemodynamic failure and management with extended stenting
  • Sigmoid Sinus Diverticulum, Dehiscence, and Venous Sinus Stenosis: Potential Causes of Pulsatile Tinnitus in Patients with Idiopathic Intracranial Hypertension?
  • Patency of the vein of Labbe after venous stenting of the transverse and sigmoid sinuses
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  • Computational Modeling of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension
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  • Venous sinus stenting for idiopathic intracranial hypertension is not associated with cortical venous occlusion
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  • Stents for Idiopathic Intracranial Hypertension: Meta-Analyzed, Hypo-Analyzed, and In Need of a Trial
  • Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes
  • Meta-Analysis of CSF Diversion Procedures and Dural Venous Sinus Stenting in the Setting of Medically Refractory Idiopathic Intracranial Hypertension
  • Delayed relapse in pseudotumor cerebri due to new stenosis after transverse sinus stenting
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  • A practical approach to, diagnosis, assessment and management of idiopathic intracranial hypertension
  • Transverse Sinus Stenting for Pseudotumor Cerebri: A Cost Comparison with CSF Shunting
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  • Venous sinus stenting for idiopathic intracranial hypertension: a review of the literature
  • Concomitant intracranial pressure monitoring during venous sinus stenting for intracranial hypertension secondary to venous sinus stenosis
  • Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis
  • Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension
  • Update on the pathophysiology and management of idiopathic intracranial hypertension
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