Regev Tamir, Fried-Regev Noa, Leeman Samuel, Walter Eyal, Wattad Mohammed, Barrett Chiya, Ben-Arie Gal, Kravetz Liron, Steen Yana Mechnik, Tsumi Erez, Horev Anat
Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University, Beer Sheva, Israel.
Department of Emergency Medicine, Soroka University Medical Center, Beer Sheva, Israel.
Quant Imaging Med Surg. 2025 May 1;15(5):4796-4815. doi: 10.21037/qims-24-2273. Epub 2025 Apr 17.
Fulminant idiopathic intracranial hypertension (FIIH) is a rapidly progressive condition that carries a high risk of permanent vision loss, and is thus considered a medical emergency requiring immediate intervention. Cerebral venous sinus stenting (VSS) has gained recognition in recent years as an effective treatment for idiopathic intracranial hypertension (IIH) in patients resistant or intolerant to medical therapy. The advantage of VSS over other surgical options is its less invasive nature (endovascular procedure) and its potential to yield improvement of additional disease symptoms, such as headaches and pulsatile tinnitus. While growing evidence supports the safety and efficacy of VSS in elective cases, data on its outcomes when performed emergently in FIIH is limited and even scarcer regarding its use during pregnancy.
This is a retrospective description of two pregnant women in their second trimester presenting with signs and symptoms of FIIH that were both refractory to medical treatment and had demonstrated progressive visual field loss. Both patients underwent emergent cerebral VSS, with no intra- or post-procedural complications. Both patients experienced a marked resolution of their symptoms following the operation and successfully delivered healthy newborns via elective cesarean section at 37 weeks of pregnancy.
This report contributes additional data to the small growing body of evidence regarding FIIH treatment in pregnancy. Based on these two cases, emergent VSS treatment for FIIH in pregnant women can be considered a valid treatment option.
暴发性特发性颅内高压（FIIH）是一种快速进展的疾病，具有永久性视力丧失的高风险，因此被视为需要立即干预的医疗紧急情况。近年来，脑静脉窦支架置入术（VSS）已被公认为是治疗对药物治疗耐药或不耐受的特发性颅内高压（IIH）患者的有效方法。VSS相对于其他手术选择的优势在于其侵入性较小（血管内手术），并且有可能改善其他疾病症状，如头痛和搏动性耳鸣。虽然越来越多的证据支持VSS在择期病例中的安全性和有效性，但关于其在FIIH紧急情况下的结果的数据有限，而关于其在怀孕期间使用的数据甚至更少。
这是对两名孕中期孕妇的回顾性描述，她们均表现出FIIH的体征和症状，对药物治疗均无效，并已出现进行性视野缺损。两名患者均接受了紧急脑VSS，术中及术后均无并发症。两名患者术后症状均明显缓解，并在妊娠37周时通过择期剖宫产成功分娩健康新生儿。
本报告为关于妊娠期FIIH治疗的少量且不断增加的证据补充了更多数据。基于这两个病例，孕妇FIIH的紧急VSS治疗可被视为一种有效的治疗选择。
