Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Neurointerv Surg. 2024 Nov 22;16(12):1264-1267. doi: 10.1136/jnis-2024-022174.
Venous sinus stenting (VSS) has been shown to reduce intracranial venous pressures and improve symptoms in patients with idiopathic intracranial hypertension (IIH). However, long-term follow-up data are limited, raising concerns about sustained symptom improvement. We aimed to assess long-term outcomes of VSS compared with ventriculoperitoneal shunting (VPS).
A retrospective case-control study assessed 87 patients with IIH who met inclusion criteria and underwent either VSS (n=27) or VPS (n=60) between 2017 and 2022. Descriptive statistics for baseline characteristics and outcomes were calculated, followed by multivariate logistic regression to identify factors associated with headache recurrence.
Baseline characteristics were similar between VSS and VPS groups, including age (p=0.58), sex (p=0.74), body mass index (p=0.47), and preoperative lumbar puncture opening pressure (p=0.62). Preoperative symptoms of headaches (p=0.42), papilledema (p=0.35), and pulsatile tinnitus (p=0.56) were also similar. Initial headache improvement was comparable (96% vs 91%, p=0.42). However, headache recurrence was less common in the VSS group (31% vs 60%, p=0.015) at the last follow-up, averaging over 1 year. Multivariate analysis showed VSS was independently associated with reduced odds of headache recurrence (OR 0.24, p=0.015). Longer follow-up was associated with increased odds of headache recurrence in both groups (OR 1.01, p=0.032).
VSS was independently associated with reduced odds of headache recurrence compared with VPS in multivariate analysis. Longer follow-up was significantly associated with headache recurrence in both groups. This suggests that VSS may lead to better outcomes for continued headache relief, but headache recurrence may increase with longer follow-up regardless of treatment modality.
静脉窦支架置入术（VSS）已被证明可降低特发性颅内高压（IIH）患者的颅内静脉压并改善症状。然而，长期随访数据有限，这引发了对症状持续改善的担忧。我们旨在评估 VSS 与脑室-腹腔分流术（VPS）相比的长期疗效。
一项回顾性病例对照研究评估了 2017 年至 2022 年间符合纳入标准并接受 VSS（n=27）或 VPS（n=60）治疗的 87 例 IIH 患者。计算了基线特征和结局的描述性统计数据，随后进行多变量逻辑回归以确定与头痛复发相关的因素。
VSS 和 VPS 组的基线特征相似，包括年龄（p=0.58）、性别（p=0.74）、体重指数（p=0.47）和术前腰椎穿刺开放压（p=0.62）。术前头痛（p=0.42）、视乳头水肿（p=0.35）和搏动性耳鸣（p=0.56）等症状也相似。初始头痛改善情况相当（96% vs 91%，p=0.42）。然而，在最后一次随访时，VSS 组头痛复发较少（31% vs 60%，p=0.015），平均随访时间超过 1 年。多变量分析显示，VSS 与头痛复发的可能性降低独立相关（OR 0.24，p=0.015）。两组的随访时间延长均与头痛复发的可能性增加相关（OR 1.01，p=0.032）。
多变量分析显示，与 VPS 相比，VSS 与头痛复发的可能性降低独立相关。两组的随访时间延长均与头痛复发显著相关。这表明 VSS 可能导致更好的持续头痛缓解结果，但无论治疗方式如何，头痛复发的可能性都会随着随访时间的延长而增加。
