Department of Neurology, Soroka Medical Center, Beer Sheva, Israel.
Department of Radiology, Soroka Medical Center, Beer Sheva, Israel.
J Neurol Sci. 2023 Sep 15;452:120761. doi: 10.1016/j.jns.2023.120761. Epub 2023 Aug 2.
Fulminant idiopathic intracranial hypertension (FIIH) is characterized by rapid, severe, progressive vision loss and often treated surgically. Cerebral transverse venous stenting (CTVS) is efficacious in IIH patients, but emergent CTVS in FIIH is rarely reported. We present our experience with emergent CTVS in patients with FIIH.
Since 01/2019, an institutional protocol allowed emergent CTVS in FIIH patients with bilateral transverse sinus stenosis and gradient pressure > 15 on digital subtraction angiography (DSA). We retrospectively analyzed a prospective registry of all IIH patients with details of neurological and neuro-ophthalmological assessments before and after treatment, and subjective assessments of headache and tinnitus were made pre-and post-procedure.
259 IIH patients, including 49 who underwent CTVS, were registered. Among them, five female patients met inclusion criteria for FIIH and underwent emergent CTVS. FIIH patients were younger (18.8 ± 1.64 vs 27.7 ± 4.85, p < 0.01), mean BMI was lower (30.8 ± 10.57 vs 34.6 ± 4.3, p < 0.01), and lumbar puncture opening pressure higher (454 ± vs 361 ± 99.4, p < 0.01) than that of IIH patients. They presented with acute visual loss, severe headache, papilledema, significant bilateral transverse sinus stenosis on CT-venography, and mean dominant side gradient pressure of 26.4 ± 6.2 on DSA. CTVS was performed without significant complications, resulting in remarkable improvement in headache, optical coherence tomography, and visual fields within 1 week. At 1-year follow-up (four patients) and 6-month follow-up (1 patient), there was complete resolution of papilledema and headache, and marked improvement in visual acuity.
In these patients, emergent-CTVS was a safe and effective treatment option for FIIH. Further evaluation is warranted.
暴发性特发性颅内高压（FIIH）的特点是视力迅速、严重、进行性下降，常需手术治疗。脑横窦支架置入术（CTVS）对 IIH 患者有效，但 FIIH 中紧急 CTVS 很少报道。我们报告了我们在 FIIH 患者中进行紧急 CTVS 的经验。
自 2019 年 1 月以来，一项机构方案允许在 DSA 显示双侧横窦狭窄和梯度压力>15mmHg 的 FIIH 患者中进行紧急 CTVS。我们回顾性分析了一项前瞻性登记的所有 IIH 患者的详细资料，包括治疗前后的神经和神经眼科评估，以及治疗前后头痛和耳鸣的主观评估。
登记了 259 例 IIH 患者，其中 49 例行 CTVS。其中，5 名女性患者符合 FIIH 的纳入标准，并接受了紧急 CTVS。FIIH 患者更年轻（18.8±1.64 岁 vs 27.7±4.85 岁，p<0.01），平均 BMI 更低（30.8±10.57 千克/平方米 vs 34.6±4.3 千克/平方米，p<0.01），腰椎穿刺开放压更高（454±毫米汞柱 vs 361±99.4 毫米汞柱，p<0.01）。她们表现为急性视力丧失、严重头痛、视盘水肿、CT 静脉造影显示双侧横窦显著狭窄，DSA 上优势侧梯度压力平均为 26.4±6.2mmHg。CTVS 无明显并发症，1 周内头痛、光学相干断层扫描和视野显著改善。在 1 年随访（4 例）和 6 个月随访（1 例）时，视盘水肿和头痛完全缓解，视力明显改善。
在这些患者中，紧急 CTVS 是治疗 FIIH 的安全有效方法。需要进一步评估。
