Endovascular Dural Venous Sinus Stenting for the Treatment of Papilledema in Idiopathic Intracranial Hypertension

Abstract

Introduction: Recently a subset of patients with Benign Intracranial hypertension has been identified that have cerebral dural venous stenosis. Recent studies have demonstrated that venous sinus stenting can result in normalization of these pressures and resultant resolution of ophthalmologic findings. Methods: Twenty-six patients were referred to a single institution for optic nerve swelling due to Benign Intracranial hypertension and found to have cerebral dural venous sinus stenosis. These patients subsequently underwent cerebral venous sinus stenting. Ophthalmic manifestations were evaluated pre and post procedure as well as intravascular pressure measurements and pressure gradients before and after the stenting procedure. The pre and postoperative ophthalmologic findings were tabulated as well as the pre and post procedure pressure measurements before and after stenting. Results: The average preprocedural pressure gradient measured 13.8 mmHg and was reduced to 1.3 mmHg after the stenting procedure. 25 of 26 patients had improvement in their papilledema after the stenting procedure. No complications occurred during or after the procedure. Conclusion: Endovascular Dural Venous sinus stenting is a safe and effective treatment modality for the ophthalmic manifestations of Benign Intracranial Hypertension in those patients found to have cerebral venous sinus stenosis. Check for updates and occasionally Optical Coherence Tomography (OCT). OCT is a newer methodology that delineates the thickness of the retinal nerve fiber layer (RNFL) which may be increased in acute cases of IIH or demonstrate thinning with chronic cases of IIH [3,4]. Thinning of the RNFL has been correlated with visual changes on automated perimetry testing [5]. These findings frequently occur in the setting of a patient with retrobulbar pain with or without subjective visual changes. Citation: Maloney TG, Oros J, George R, et al. (2021) Endovascular Dural Venous Sinus Stenting for the Treatment of Papilledema in Idiopathic Intracranial Hypertension. J Ophthalmic Surg 4(1):27-29 Maloney TG et al. J Ophthalmic Surg 2021, 4(1):27-29 Open Access | Page 28 | The average BMI of our patient population was 36.5 (range 20.2 to 62.1). If the patient had a history of prior Dural venous sinus thrombosis, web formation often occurred which necessitates angioplasty prior to stent deployment. The authors note that if angioplasty is not performed in those patients with history of dural venous sinus thrombosis, the deployed stent will often have a narrow waist which prevents complete stent expansion without angioplasty.