Department of Neurological Surgery, NewYork-Presbyterian, Weill Cornell Medicine, 525 E 68th St, Box 99, New York, NY, 10065, USA.
Department of Otolaryngology, NewYork-Presbyterian, Weill Cornell Medicine, New York, NY, USA.
Acta Neurochir (Wien). 2023 Aug;165(8):2283-2292. doi: 10.1007/s00701-023-05680-w. Epub 2023 Jun 21.
Chronically elevated intracranial pressure (ICP) seen in idiopathic intracranial hypertension (IIH) can cause the development of skull base encephaloceles and cerebrospinal fluid (CSF) leaks. Surgical repair and ventriculoperitoneal shunt (VPS) placement are mainstays of treatment. Venous sinus stenting (VSS) is a newly accepted treatment modality. The goal of this study was thus to determine if VSS can be used to treat symptoms and prevent recurrence after surgical encephalocele repair.
Retrospective chart review of patients that had surgical repair of encephaloceles followed by VSS for symptomatic stenosis with elevated pressure gradient.
A total of 13 patients underwent a combined encephalocele repair and VSS. Seventy-two percent were female; 46% had headaches, 69% pulsatile tinnitus, and 92% CSF rhinorrhea or otorrhea. One had seizures. Mean lumbar opening pressure was 23.3 ± 2.6 cm HO; the average sagittal-to-jugular pressure gradient was 12.7 ± 1.8 cmHO and was elevated in all patients. Four patients had middle fossa craniotomy for repair of tegmen defect (one bilateral); one had a retrosigmoid craniotomy for repair of a sigmoid plate defect. Eight had an endoscopic endonasal repair for sphenoid or cribriform plate encephalocele. There were no VSS procedural complications or complications associated with dual antiplatelet therapy. One patient had meningitis after endoscopic repair that was treated with antibiotics. One patient had recurrence of both CSF leak and venous stenosis adjacent to the stent requiring repeat repair and VSS. There was no further recurrence.
In patients with dural sinus stenosis and encephaloceles requiring repair, VSS can be performed safely within weeks of surgery for relief of symptoms, resolution of underlying pathology, and prevention of CSF leak recurrence.
特发性颅内高压（IIH）患者颅内压持续升高，可导致颅底脑膨出和脑脊液（CSF）漏的发生。手术修复和脑室腹腔分流术（VPS）是主要的治疗方法。静脉窦支架置入术（VSS）是一种新的治疗方式。本研究旨在确定 VSS 是否可用于治疗症状，并预防手术后脑膨出修复后的复发。
对接受手术修复脑膨出后因症状性狭窄和压力梯度升高而行 VSS 的患者进行回顾性图表分析。
共 13 例患者接受了脑膨出修复联合 VSS。72%为女性；46%有头痛，69%有搏动性耳鸣，92%有 CSF 鼻漏或耳漏。1 例有癫痫发作。平均腰椎穿刺压力为 23.3±2.6cmHO；平均矢状窦-颈静脉压力梯度为 12.7±1.8cmHO，所有患者均升高。4 例患者行中颅窝开颅术修复天幕缺损（双侧 1 例）；1 例患者行乙状窦后开颅术修复乙状窦板缺损。8 例行内镜经鼻蝶入路修复蝶骨或筛板脑膨出。VSS 手术过程中无并发症，也无与双联抗血小板治疗相关的并发症。1 例内镜修复后并发脑膜炎，经抗生素治疗。1 例患者 CSF 漏和支架附近静脉狭窄均复发，需再次修复和 VSS。无进一步复发。
对于需要修复的硬脑膜窦狭窄和脑膨出患者，VSS 可在手术后数周内安全进行，以缓解症状、解决潜在病理问题并预防 CSF 漏复发。
