Chandran Arun, Pulhorn Heinke, McMahon Catherine
a Neuroradiology , The Walton Centre , Liverpool , UK.
b Neurosurgery , The Walton Centre , Liverpool , UK.
Br J Neurosurg. 2019 Feb;33(1):71-75. doi: 10.1080/02688697.2017.1374349. Epub 2017 Sep 21.
Headaches, visual problems and tinnitus are symptoms of Idiopathic Intracranial Hypertension (IIH) which resolve with reduction of CSF pressure. Impaired cranial venous outflow has been implicated in the pathogenesis and there is evidence of good treatment results in IIH using venous sinus stenting. We are currently initiating a multi-centre randomised controlled trial, the VISION study (Venous Intervention versus Shunting in IIH for Optic Disc Swelling) comparing radiological (venous sinus stenting) to surgical intervention (CSF shunting). As part of the preparations for VISION we made a basic questionnaire available to members of the website IIH UK ( www.iih.org.uk ).
10-point questionnaire pertaining to IIH diagnosis, symptoms and management using www.surveymonkey.com .
250 questionnaires were returned. 95.6% of respondents were female, mostly ≤40 years of age. 70% were diagnosed in the last 5 years, but only 35% were diagnosed less than a year after onset of symptoms. 59.4% of patients had not undergone any radiological/surgical intervention, 34.9% had had CSF diversion, 3.6% venous stenting and 2.0% had stent plus shunt. 16.8% indicated their lives were most affected by tinnitus and 18.1% by visual problems, but 49.6% said they were most affected by their headaches. 81% of patients indicated they would be happy to participate in a randomised trial comparing the two treatment options of venous stenting and CSF shunting.
IIH patients want to be actively involved in their treatment and are favourably disposed towards clinical research. Variation exists in treatment modalities offered. There are individual differences regarding impact of symptoms.
头痛、视力问题和耳鸣是特发性颅内高压(IIH)的症状,这些症状会随着脑脊液压力的降低而缓解。颅内静脉流出受损与该病的发病机制有关,并且有证据表明,使用静脉窦支架置入术治疗IIH可取得良好的治疗效果。我们目前正在开展一项多中心随机对照试验,即VISION研究(特发性颅内高压性视神经乳头水肿的静脉介入与分流治疗),比较放射治疗(静脉窦支架置入术)与手术干预(脑脊液分流术)。作为VISION研究准备工作的一部分,我们向英国IIH网站(www.iih.org.uk)的成员提供了一份基本调查问卷。
使用www.surveymonkey.com网站提供一份关于IIH诊断、症状和治疗的10分制调查问卷。
共收回250份调查问卷。95.6%的受访者为女性,大多数年龄≤40岁。70%的患者在过去5年内被确诊,但只有35%的患者在症状出现后不到一年就被确诊。59.4%的患者未接受任何放射/手术干预,34.9%的患者接受了脑脊液分流术,3.6%的患者接受了静脉支架置入术,2.0%的患者接受了支架加分流术。16.8%的患者表示耳鸣对其生活影响最大,18.1%的患者表示视力问题影响最大,但49.6%的患者表示头痛对其影响最大。81%的患者表示愿意参与一项比较静脉支架置入术和脑脊液分流术这两种治疗方案的随机试验。
IIH患者希望积极参与治疗,并且对临床研究持支持态度。所提供的治疗方式存在差异。症状的影响存在个体差异。