1Faculty of Medicine Cairo University, 2King Hamad University Hospital
Idiopathic intracranial hypertension (IIH) is a disabling disease its prevalence of one per 100,000 predominant in women Its Pathophysiology is related to increased intracranial pressure. Symptoms classically consist of chronic headaches, papilledema, and visual impairment. Traditional treatments involve decreasing Cerebrospinal pressure (CSF) though weight control, acetazolamide, CSF diversion, or optic nerve fenestration. However, all previous treatments didn’t target the cause of elevated CSF pressure rather than to relieve the pressure. Recently venous sinus stenting is targeting an important pathophysiologic mechanism which is symptomatic dural sinus stenosis, It provides more physiological management of Increased ICP and Improve symptoms as well as reduce unnecessary drug side effects.
Material(s) and Method(s):
6 patients with resistant IIH, 2 of them had hypoplasia of the contralateral side with significant stenosis of the main lateral sinus. Pressure gradient was measured across the stenosis and was found 80+ mmH2O using microcatheter, A Stent was placed across the stenotic area with measurement of pressure gradient across the stent which showed immediate improvement of the pressure gradient across the stent.
All Patients were medicated with dual antiplatelet therapy.
All patients had improvement of pressure gradient as well as their symptoms with reduction of papilledema on subsequent neuroophthalmological assessment, No Procedure related Complication.
Dural Sinus Stenting is a safe effective procedure in the treatment of IIH where there is symptomatic dural sinus stenosis.