Kalsoum Erwah, Scarcia Luca, Abdalkader Mohamad, Dmytriw Adam A, Farhat Firas, Tuilier Titien, Geismar Maxime, Quesnel Christophe, Tourbah Ayman, Abdellaoui Mohamed, Nguyen Thanh N, Kikano Raghid, El Ojaimi Rami
Department of Neuroradiology, Henri Mondor Hospital, Créteil, France.
Department of Neuroradiology, CHU Henri Mondor, Creteil, France.
J Neurointerv Surg. 2025 Aug 13;17(9):939-942. doi: 10.1136/jnis-2024-022109.
Venous sinus stenting (VSS) is an increasingly performed procedure for the treatment of idiopathic intracranial hypertension (IIH) refractory to medical treatment. VSS is typically performed under general anesthesia.
To present our experience of VSS in patients with IIH performed under conscious sedation.
Retrospective review of a prospectively maintained database of all patients with IIH who underwent VSS in a single center between September 2019 and January 2024. The sedation protocol consisted of a remifentanil-based target-controlled infusion. Patients' clinical and radiological data, dosage of anesthesia, procedural characteristics, and outcomes were collected.
Twenty-six patients with IIH underwent venous manometry (VM) and VSS under awake sedation and were included in our study. Patients were predominantly women (24/26) with a median age (IQR) of 33 (13) years. The median (IQR) body mass index was 34 (10) kg/m. There was no need for general anesthesia conversion. Technical success was achieved in all patients. Median (IQR) follow-up after stenting was 7 (2) months. All patients reported resolution of the pulsatile tinnitus; headaches regressed in 20/24 (83.3%) patients and papilledema improved in 16/20 (80%). Only one non-neurological complication (retroperitoneal hematoma) occurred, without any permanent morbidity or mortality.
Our study confirms that performing VM and VSS under conscious sedation is safe and feasible. Conscious sedation is a viable alternative to general anesthesia for managing IIH in these patients.
静脉窦支架置入术（VSS）是治疗难治性特发性颅内高压（IIH）的一种应用日益广泛的手术。VSS通常在全身麻醉下进行。
介绍我们在清醒镇静下对IIH患者进行VSS的经验。
回顾性分析2019年9月至2024年1月在单一中心接受VSS的所有IIH患者的前瞻性维护数据库。镇静方案包括基于瑞芬太尼的靶控输注。收集患者的临床和影像学数据、麻醉剂量、手术特征及结果。
26例IIH患者在清醒镇静下接受了静脉测压（VM）和VSS，并纳入我们的研究。患者以女性为主（24/26），中位年龄（四分位间距）为33（13）岁。中位（四分位间距）体重指数为34（10）kg/m²。无需转为全身麻醉。所有患者均取得技术成功。支架置入后的中位（四分位间距）随访时间为7（2）个月。所有患者均报告搏动性耳鸣消失；20/24（83.3%）的患者头痛减轻，16/20（80%）的患者视乳头水肿改善。仅发生1例非神经系统并发症（腹膜后血肿），无任何永久性发病或死亡。
我们的研究证实，在清醒镇静下进行VM和VSS是安全可行的。清醒镇静是这些患者管理IIH时全身麻醉的一种可行替代方法。
