特发性颅内高压治疗内在和外在狭窄的特征及结果：中国单中心经验

Characteristics and Outcomes of the Idiopathic Intracranial Hypertension Treatment in Intrinsic and Extrinsic Stenosis: A Single-Center Experience in China.

作者信息

Huo Xiaochuan, Yang Hongchao, Wang Zhengyang, Tong Xu, Li Xiaoqing, Liu Lian, Wang Shuran, Miao Zhongrong, Mo Dapeng

机构信息

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, the South Fourth Ring West Road, Fengtai district, Beijing, 100070, China.

Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.

出版信息

Neurol Ther. 2021 Dec;10(2):1029-1044. doi: 10.1007/s40120-021-00281-0. Epub 2021 Sep 20.

DOI:10.1007/s40120-021-00281-0

PMID:34542867

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8571462/

Abstract

INTRODUCTION

This study aimed to explore the precipitating factors and evaluate the impact of different stenosis types on treatment outcomes in patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS).

METHODS

We recruited patients with IIH who presented with VSS, either intrinsic or extrinsic. We observed the clinical and laboratory findings, and we then compared the outcomes of stenting and medical treatment in different stenosis types.

RESULTS

Among 145 patients with IIH and VSS, 59 were of the intrinsic type and 86 were of the extrinsic type. Patients in the intrinsic group were older (42 vs. 34 years old, P < 0.001) and presented with higher pre-op gradient pressure (15 mmHg vs. 12 mmHg, P < 0.001). There was no significant difference between groups regarding other precipitating factors (P > 0.05). Stenting was significantly associated with complete resolution of the headache and impaired vision both in intrinsic (adjusted OR 0.017, 95% CI 0.001-0.35, P = 0.011; adjusted OR 0.056, 95% CI 0.004-0.697, P = 0.025, respectively) and extrinsic types of stenosis (adjusted OR 0.072, 95% CI 0.015-0.343, P = 0.001; adjusted OR 0.241, 95% CI 0.062-0.931, P = 0.039, respectively). Meanwhile, stenting was significantly associated with improvement of the papilledema in extrinsic-type stenosis compared with medical treatment (adjusted OR 0.017, 95% CI 0.002-0.135, P < 0.001).

CONCLUSION

Stenting may provide substantial clinical improvement in patients with IIH regardless of intrinsic or extrinsic stenosis type in our patient population, as noted in other series.

TRIAL REGISTRATION

Clinical trial registration number ChiCTR-ONN-17010421.

摘要

引言

本研究旨在探讨特发性颅内高压（IIH）合并静脉窦狭窄（VSS）患者的诱发因素，并评估不同狭窄类型对治疗结果的影响。

方法

我们招募了患有内在性或外在性VSS的IIH患者。我们观察了临床和实验室检查结果，然后比较了不同狭窄类型的支架置入术和药物治疗的结果。

结果

在145例IIH合并VSS患者中，59例为内在型，86例为外在型。内在型组患者年龄较大（42岁对34岁，P<0.001），术前梯度压力较高（15mmHg对12mmHg，P<0.001）。在其他诱发因素方面，两组之间无显著差异（P>0.05）。支架置入术与内在型（校正OR 0.017，95%CI 0.001-0.35，P=0.011；校正OR 0.056，95%CI 0.004-0.697，P=0.025）和外在型狭窄（校正OR 0.072，95%CI 0.015-0.343，P=0.001；校正OR 0.241，95%CI 0.062-0.931，P=0.039）患者的头痛完全缓解和视力损害均显著相关。同时，与药物治疗相比，支架置入术与外在型狭窄患者视乳头水肿的改善显著相关（校正OR 0.017，95%CI 0.002-0.135，P<0.001）。