Departments of 1 Neurological Surgery.
Radiology and Medical Imaging.
J Neurosurg. 2017 Nov;127(5):1126-1133. doi: 10.3171/2016.8.JNS16879. Epub 2016 Dec 23.
OBJECTIVE Idiopathic intracranial hypertension (IIH) may cause blindness due to elevated intracranial pressure (ICP). Venous sinus stenosis has been identified in select patients, leading to stenting as a potential treatment, but its effects on global ICP have not been completely defined. The purpose of this pilot study was to assess the effects of venous sinus stenting on ICP in a small group of patients with IIH. METHODS Ten patients for whom medical therapy had failed were prospectively followed. Ophthalmological examinations were assessed, and patients with venous sinus stenosis on MR angiography proceeded to catheter angiography, venography with assessment of pressure gradient, and ICP monitoring. Patients with elevated ICP measurements and an elevated pressure gradient across the stenosis were treated with stent placement. RESULTS All patients had elevated venous pressure (mean 39.5 ± 14.9 mm Hg), an elevated gradient across the venous sinus stenosis (30.0 ± 13.2 mm Hg), and elevated ICP (42.2 ± 15.9 mm Hg). Following stent placement, all patients had resolution of the stenosis and gradient (1 ± 1 mm Hg). The ICP values showed an immediate decrease (to a mean of 17.0 ± 8.3 mm Hg), and further decreased overnight (to a mean of 8 ± 4.2 mm Hg). All patients had subjective and objective improvement, and all but one improved during follow-up (median 23.4 months; range 15.7-31.6 months). Two patients developed stent-adjacent stenosis; retreatment abolished the stenosis and gradient in both cases. Patients presenting with papilledema had resolution on follow-up funduscopic imaging and optical coherence tomography (OCT) and improvement on visual field testing. Patients presenting with optic atrophy had optic nerve thinning on follow-up OCT, but improved visual fields. CONCLUSIONS For selected patients with IIH and venous sinus stenosis with an elevated pressure gradient and elevated ICP, venous sinus stenting results in resolution of the venous pressure gradient, reduction in ICP, and functional, neurological, and ophthalmological improvement. As patients are at risk for stent-adjacent stenosis, further follow-up is necessary to determine long-term outcomes and gain an understanding of venous sinus stenosis as a primary or secondary pathological process behind elevated ICP.
特发性颅内高压（IIH）可因颅内压（ICP）升高而导致失明。在某些患者中已发现静脉窦狭窄，导致支架置入成为一种潜在的治疗方法，但静脉窦狭窄对全局 ICP 的影响尚未完全明确。本研究的目的是评估静脉窦支架置入术对一小部分 IIH 患者 ICP 的影响。
前瞻性随访了 10 名药物治疗失败的患者。进行了眼科检查，对 MR 血管造影显示静脉窦狭窄的患者进行了导管血管造影、静脉造影并评估压力梯度，以及 ICP 监测。对 ICP 测量值升高且狭窄处压力梯度升高的患者进行支架置入治疗。
所有患者的静脉压均升高（平均 39.5 ± 14.9mmHg），静脉窦狭窄处压力梯度升高（30.0 ± 13.2mmHg），ICP 升高（42.2 ± 15.9mmHg）。支架置入后，所有患者的狭窄和梯度均得到缓解（1 ± 1mmHg）。ICP 值立即下降（平均 17.0 ± 8.3mmHg），并在夜间进一步下降（平均 8 ± 4.2mmHg）。所有患者均有主观和客观改善，除 1 例外，所有患者在随访期间均有改善（中位数 23.4 个月；范围 15.7-31.6 个月）。2 例患者出现支架附近狭窄；再次治疗后，两种情况下狭窄和梯度均消失。有乳头水肿的患者在随访眼底成像和光学相干断层扫描（OCT）上水肿消退，视野检查改善。有视神经萎缩的患者在随访 OCT 上视神经变薄，但视野改善。
对于伴有静脉窦狭窄、压力梯度升高和 ICP 升高的 IIH 患者，静脉窦支架置入术可使静脉压力梯度得到缓解，ICP 降低，并改善神经功能、视力和眼部表现。由于患者存在支架附近狭窄的风险，需要进一步随访以确定长期结果，并了解静脉窦狭窄作为 ICP 升高的原发性或继发性病理过程。
