Matloob Samir A, Toma Ahmed K, Thompson Simon D, Gan Chee L, Robertson Fergus, Thorne Lewis, Watkins Laurence D
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
Acta Neurochir (Wien). 2017 Aug;159(8):1429-1437. doi: 10.1007/s00701-017-3229-6. Epub 2017 May 31.
Idiopathic intracranial hypertension (IIH) is characterised by an increased intracranial pressure (ICP) in the absence of any central nervous system disease or structural abnormality and by normal CSF composition. Management becomes complicated once surgical intervention is required. Venous sinus stenosis has been suggested as a possible aetiology for IIH. Venous sinus stenting has emerged as a possible interventional option. Evidence for venous sinus stenting is based on elimination of the venous pressure gradient and clinical response. There have been no studies demonstrating the immediate effect of venous stenting on ICP.
Patients with a potential or already known diagnosis of IIH were investigated according to departmental protocol. ICP monitoring was performed for 24 h. When high pressures were confirmed, CT venogram and catheter venography were performed to look for venous stenosis to demonstrate a pressure gradient. If positive, venous stenting would be performed and ICP monitoring would continue for a further 24 h after deployment of the venous stent.
Ten patients underwent venous sinus stenting with concomitant ICP monitoring. Nine out of ten patients displayed an immediate reduction in their ICP that was maintained at 24 h. The average reduction in mean ICP and pulsatility was significant (p = 0.003). Six out of ten patients reported a symptomatic improvement within the first 2 weeks.
Venous sinus stenting results in an immediate reduction in ICP. This physiological response to venous stenting has not previously been reported. Venous stenting could offer an alternative treatment option in correctly selected patients with IIH.
特发性颅内高压（IIH）的特征是在没有任何中枢神经系统疾病或结构异常的情况下颅内压（ICP）升高，且脑脊液成分正常。一旦需要手术干预，治疗就会变得复杂。静脉窦狭窄已被认为是IIH可能的病因。静脉窦支架置入术已成为一种可能的介入选择。静脉窦支架置入术的证据基于静脉压力梯度的消除和临床反应。尚无研究证明静脉支架置入术对ICP的即时影响。
根据科室方案对可能或已确诊为IIH的患者进行研究。进行24小时的ICP监测。当确认压力升高时，进行CT静脉造影和导管静脉造影以寻找静脉狭窄以证明压力梯度。如果结果为阳性，则进行静脉支架置入术，并在置入静脉支架后继续进行24小时的ICP监测。
10例患者接受了静脉窦支架置入术并同时进行ICP监测。10例患者中有9例的ICP立即下降，并在24小时时维持该水平。平均ICP和搏动性的平均下降幅度具有统计学意义（p = 0.003）。10例患者中有6例在最初2周内报告症状有所改善。
静脉窦支架置入术可使ICP立即下降。这种对静脉支架置入术的生理反应此前尚未见报道。静脉支架置入术可为正确选择的IIH患者提供另一种治疗选择。
