Endovascular Treatment Of Intracranial Hypertension Associated With Venous Sinus Stenosis: Clinical Research In 29 Patients

Object:Idiopathic intracranial hypertension(IIH)is a disorder of increased intracranial pressure in the absence of any known causative factor,mainly affecting obese women of childbearing age.Studies have shown that a high proportion of IIH patients present with nonthrombotic unilateral or bilateral cerebral venous sinus stenosis.Based on this etiology,endovascular treatment is increasingly used in clinical practice.We evaluated the safety and efficacy of endovascular treatment in IIH with venous sinus stenosis.Methods:This research was a single-center retrospective study.We continuously included patients with IIH and venous sinus stenosis were treated with endovascular therapy in the cerebrovascular disease center of the department of neurology,the first hospital of Jilin university.All patients underwent magnetic resonance venography(MRV)or digital subtraction angiography(DSA)before surgery to confirm the existence of intracranial venous sinus stenosis,and there was a pressure gradient on both sides of the stenosis.The success rate of operation,complications and treatment measures during and after operation and prognosis of patients were analyzed.Regular follow-up was performed to observe the improvement of clinical symptoms and whether there was deterioration or recurrence.The relevant data was represented by the mean or median.Results:A total of 29 patients were included between March 2015 and March 2022,including 26 females and 3 males.Age ranged from 14 to 52 years(median 32years).BMI ranged from 23.87 to 32.82 kg/m2 with a median of 26.56kg/m2.Preoperative lumbar puncture pressure was 210->400 mm H2 O,median370 mm H2 O.The results of venography showed that 16 cases(55.2%)had bilateral stenosis at the transverse-sigmoid junction and 1 case(3.4%)had stenosis at the right transverse-sigmoid junction.Eight patients(27.6%)had dominant right transverse sinus drainage with stenosis at the junction with the sigmoid sinus,three patients(10.3%)had dominant left sinus drainage with stenosis at the junction with the sigmoid sinus,and one patient(3.4%)had dominant right sinus drainage with stenosis at the junction with the superior sagittal sinus.The pressure gradient on both sides of the venous sinus manometry stenosis ranged from 6.4 to 53 mm Hg,with a median of 16.3mm Hg.Of the 29 patients,28 patients were successfully implanted with stents,with a procedural success rate of 96.6%.Post operative complications occurred in 3 cases: 1 case of stent thrombosis after stent implantation.Intracranial hemorrhage occurred in 1 case;1 case was terminated due to intra-operative arteriovenous fistula,and stent implantation was not successful.Patients with successful stenting had a reduction of 8-53 mm Hg in the bilateral stenotic pressure gradient postoperatively,with a median of 16.9 mm Hg.Except for one patient with successful stent implantation,the lumbar puncture pressure value did not decrease due to surgical complications.The remaining patients had a lumbar puncture pressure decrease ranging from 20 to 205 mm H2 O,with a median of 110 mm H2O.Twenty-six of the 29 patients(89.7%)were followed up clinically,and 25 of them(96.2%)complained that the clinical symptoms were partially or completely relieved after stent implantation.Conclusions:Endovascular therapy is an effective method for IIH patients with cerebral venous sinus stenosis who have not responded well to medical treatment or have intractable headache or persistent visual impairment.However,the mechanism of IIH formation is not clear,and defining the clinical type of venous sinus stenosis may help clinical decision making.Endovascular therapy is risky,and should be evaluated thoroughly before operation.