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硬脑膜静脉窦支架置入术治疗特发性颅内高压:系统评价和文献评价。

Dural venous sinus stenting in the treatment of idiopathic intracranial hypertension: A systematic review and critique of literature.

机构信息

University of Toronto.

Department of Ophthalmology and Vision Sciences, University of Toronto.

出版信息

Surv Ophthalmol. 2022 Jan-Feb;67(1):271-287. doi: 10.1016/j.survophthal.2021.05.002. Epub 2021 May 15.

Abstract

Idiopathic intracranial hypertension (IIH) is increased intracranial pressure without a known cause. Dural venous sinus stenting (DVSS) is a relatively new intervention for treatment of IIH refractory to medical therapy and lifestyle modifications. In this review, we outline various hypotheses of IIH pathogenesis and describe the role of venous sinus stenosis and the technical details of DVSS. We also present a summary and critique of the available evidence describing the outcomes of DVSS in IIH and review the evidence-based guidelines for this procedure. We conclude that, although many studies have shown generally favorable outcomes of DVSS in patients with IIH, most have serious limitations, the most common one being paucity of pre- and postprocedure ophthalmological data. Thus, there is not enough available evidence to conclude whether DVSS is an effective procedure for treatment of IIH. We also present the most commonly used indications for DVSS as described in the literature and stress the importance of neuro-ophthalmological assessment before and after the procedure to monitor response and potential complications.

摘要

特发性颅内高压(IIH)是指不明原因的颅内压增高。硬脑膜静脉窦支架置入术(DVSS)是一种相对较新的干预措施,用于治疗对药物治疗和生活方式改变无效的 IIH。在这篇综述中,我们概述了 IIH 发病机制的各种假设,并描述了静脉窦狭窄的作用和 DVSS 的技术细节。我们还总结并评价了现有的关于 IIH 患者行 DVSS 治疗的结果的证据,并回顾了该手术的循证指南。我们得出结论,尽管许多研究表明 IIH 患者行 DVSS 治疗的总体结果良好,但大多数研究都存在严重的局限性,最常见的是缺乏术前和术后眼科数据。因此,目前尚无足够的证据可以得出结论认为 DVSS 是治疗 IIH 的有效方法。我们还介绍了文献中描述的 DVSS 最常用的适应证,并强调了在手术前后进行神经眼科评估的重要性,以监测反应和潜在的并发症。

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