Assessment of Reversibility of Transverse Venous Sinus Stenosis in Patients With Papilledema.

IF 2 4区 医学 Q3 CLINICAL NEUROLOGY
Journal of Neuro-Ophthalmology Pub Date : 2025-03-01 Epub Date: 2024-02-19 DOI:10.1097/WNO.0000000000002090
Armin Handzic, Brendan K Tao, Roisin M O'Cearbhaill, Patrick J Nicholson, Edward A Margolin, Jonathan A Micieli
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引用次数: 0

Abstract

Background: Bilateral transverse venous sinus stenosis (TVSS) or stenosis of a dominant venous sinus has been found to be very sensitive radiological findings in patients with intracranial hypertension (IH), yet there is still an ongoing debate whether they constitute reversible or permanent phenomena. Thus, the purpose of this study was to investigate the reversibility of TVSS in patients with IH, including conservatively treated patients with signs of IH as defined by the presence of papilledema.

Methods: This was a retrospective chart review of all patients diagnosed with IH between 2016 and 2022, assessed from 2 tertiary university-affiliated neuro-ophthalmology practices. Inclusion criteria were the presence of papilledema, as quantified by optical coherence tomography, and bilateral TVSS, which is considered typical of IH on neuroimaging. During follow-up, included patients must have had confirmation of papilledema resolution as well as subsequent neuroimaging after conservative treatment or cerebrospinal fluid flow diversion. Patients with dural sinus vein thrombosis or intrinsic stenosis from sinus trabeculations or significant arachnoid granulations were excluded from the study. Either CT venography or MRI/MR venography was reviewed by a fellowship-trained neuroradiologist, and the degree of stenosis was scored through the combined conduit score (CCS), as described by Farb et al. The primary outcome was to assess TVSS changes after resolution or improvement of papilledema.

Results: From 435 patients, we identified a subset of 10 who satisfied all inclusion criteria. Our cohort comprised entirely women with a median age of 29.5 years and a median BMI of 32.5 kg/m 2 . Treatment consisted of acetazolamide in 7 patients, of which 1 had additional topiramate and 2 underwent cerebrospinal fluid flow diversion. Furthermore, 6 patients demonstrated significant weight loss during follow-up. For the primary outcome, 5 of 10 patients exhibited no appreciable TVSS change, and 5 patients demonstrated significant improvement in TVSS, of which 4 received conservative treatment only. Papilledema resolution or improvement was statistically significantly associated with increasing average CCS, TVSS diameter, and grade.

Conclusions: We were able to demonstrate that TVSS can be both irreversible and reversible in patients with resolved papilledema. The finding of TVSS reversibility from conservative treatment alone is novel and has important implications to optimize patient care. Future studies should work to identify factors associated with irreversible TVSS for subsequent targeted intervention and prevention.

评估乳头水肿患者横向静脉窦狭窄的可逆性
背景:双侧横向静脉窦狭窄(TVSS)或优势静脉窦狭窄已被发现是颅内高压(IH)患者非常敏感的放射学发现,但它们是可逆现象还是永久现象仍存在争议。因此,本研究的目的是调查 IH 患者 TVSS 的可逆性,包括保守治疗后出现乳头水肿的 IH 患者:这是一项回顾性病历审查,对 2016 年至 2022 年期间诊断为 IH 的所有患者进行了评估,评估对象来自 2 所三级大学附属神经眼科诊所。纳入标准为存在乳头水肿(通过光学相干断层扫描量化)和双侧TVSS(在神经影像学上被认为是典型的IH)。在随访期间,纳入的患者必须确认乳头水肿已经消退,并且在保守治疗或脑脊液流改道后进行了后续的神经影像学检查。患有硬脑膜窦静脉血栓或硬脑膜窦小梁或明显蛛网膜肉芽造成的内在狭窄的患者不在研究范围内。CT静脉造影或MRI/MR静脉造影均由受过研究培训的神经放射科医生进行审查,狭窄程度通过Farb等人描述的联合导管评分(CCS)进行评分:我们从 435 名患者中筛选出了 10 名符合所有纳入标准的患者。患者全部为女性,中位年龄为 29.5 岁,中位体重指数为 32.5 kg/m2。7 名患者接受了乙酰唑胺治疗,其中 1 人额外服用了托吡酯,2 人接受了脑脊液流改道治疗。此外,6 名患者在随访期间体重明显减轻。在主要结果方面,10 名患者中有 5 人的 TVSS 无明显变化,5 人的 TVSS 有明显改善,其中 4 人仅接受了保守治疗。据统计,乳头水肿的消退或改善与平均 CCS、TVSS 直径和等级的增加有显著相关性:我们能够证明,在乳头水肿缓解的患者中,TVSS 既可以是不可逆的,也可以是可逆的。仅靠保守治疗就能逆转 TVSS 的发现很新颖,对优化患者护理具有重要意义。今后的研究应致力于确定与不可逆转的 TVSS 相关的因素,以便进行有针对性的干预和预防。
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来源期刊
Journal of Neuro-Ophthalmology
Journal of Neuro-Ophthalmology 医学-临床神经学
CiteScore
2.80
自引率
13.80%
发文量
593
审稿时长
6-12 weeks
期刊介绍: The Journal of Neuro-Ophthalmology (JNO) is the official journal of the North American Neuro-Ophthalmology Society (NANOS). It is a quarterly, peer-reviewed journal that publishes original and commissioned articles related to neuro-ophthalmology.
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