Azzam Ahmed Y, Mortezaei Ali, Morsy Mahmoud M, Essibayi Muhammed Amir, Ghozy Sherief, Elamin Osman, Azab Mohammed A, Elswedy Adam, Altschul David, Kadirvel Ramanathan, Brinjikji Waleed, Kallmes David F
Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Faculty of Medicine, October 6 University, Giza, Egypt; Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
J Neurol Sci. 2024 Apr 15;459:122948. doi: 10.1016/j.jns.2024.122948. Epub 2024 Mar 5.
Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure and primarily affects obese women of reproductive age. Venous sinus stenting (VSS) is a surgical procedure used to treat IIH, but its safety and efficacy are still controversial.
A systematic review and meta-analysis were conducted following PRISMA guidelines. Multiple databases were searched for studies evaluating the safety and efficacy of VSS in IIH patients and meta-analysis was performed to pool the data.
A total of 36 studies involving 1066 patients who underwent VSS were included. After VSS, a significant reduction in trans-stenotic gradient pressure was observed. Patients also showed significantly lower cerebrospinal fluid (CSF) opening pressure. Clinical outcomes demonstrated improvement in tinnitus (95%), papilledema (89%), visual disturbances (88%), and headache (79%). However, 13.7% of patients experienced treatment failure or complications. The treatment failure rate was 8.35%, characterized by worsening symptoms and recurrence of IIH. The complications rate was 5.35%, including subdural hemorrhage, urinary tract infection, stent thrombus formation, and others.
VSS appears to be a safe and effective treatment option for IIH patients who are unresponsive to medical therapy or have significant visual symptoms. However, long-term outcomes and safety of the procedure require further investigation.
特发性颅内高压（IIH）的特征是颅内压升高，主要影响育龄肥胖女性。静脉窦支架置入术（VSS）是一种用于治疗IIH的外科手术，但其安全性和有效性仍存在争议。
按照PRISMA指南进行系统评价和荟萃分析。检索多个数据库，查找评估VSS在IIH患者中的安全性和有效性的研究，并进行荟萃分析以汇总数据。
共纳入36项研究，涉及1066例行VSS的患者。VSS后，跨狭窄梯度压力显著降低。患者的脑脊液（CSF）初压也显著降低。临床结果显示耳鸣（95%）、视乳头水肿（89%）、视觉障碍（88%）和头痛（79%）有所改善。然而，13.7%的患者出现治疗失败或并发症。治疗失败率为8.35%，表现为症状恶化和IIH复发。并发症发生率为5.35%，包括硬膜下出血、尿路感染、支架血栓形成等。
对于药物治疗无效或有明显视觉症状的IIH患者，VSS似乎是一种安全有效的治疗选择。然而，该手术的长期疗效和安全性需要进一步研究。
