Visual and Pharmacotherapy Outcomes After Transverse Sinus Stenting for Idiopathic Intracranial Hypertension.

IF 2 4区 医学 Q3 CLINICAL NEUROLOGY
Journal of Neuro-Ophthalmology Pub Date : 2025-03-01 Epub Date: 2024-04-17 DOI:10.1097/WNO.0000000000002156
Armin Handzic, Jim Shenchu Xie, Eef Hendriks, Pascal Mosimann, Patrick Nicholson, Jonathan Micieli, Edward Margolin
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引用次数: 0

Abstract

Background: Transverse sinus stenting (TSS) is an increasingly common treatment for patients with idiopathic intracranial hypertension (IIH). However, detailed neuro-ophthalmic evidence on visual and pharmacotherapy outcomes after TSS is scarce and heterogeneous. This study aimed to describe the visual outcomes of patients undergoing TSS for IIH and to ascertain the proportion of patients who could be weaned off intracranial pressure (ICP)-lowering medication postoperatively.

Methods: A retrospective chart review of all patients with IIH from 2 tertiary academic neuro-ophthalmology practices who underwent TSS between 2016 and 2022 was performed. Indications for stenting included failure of pharmacotherapy, intolerance of pharmacotherapy, and acute vision loss from severe papilledema. Data on demographics, symptoms, visual function, pharmacotherapy, and TSS were collected. The paired Wilcoxon rank sum test was used to compare changes in visual acuity (VA) and visual field mean deviation (VFMD) between the baseline and most recent visits.

Results: Of the 435 patients with IIH, 15 (13 women) met inclusion criteria. After TSS, ICP-lowering pharmacotherapy was discontinued in 10 patients and decreased in 4; 1 patient was not on ICP-lowering medication before TSS. All patients experienced resolution or improvement of symptoms (10 resolution, 4 improved, 1 asymptomatic before TSS) and papilledema (11 resolution, 4 improved) after stenting. Papilledema resolution was confirmed with optical coherence tomography-measured peripapillary nerve fiber layer thickness (median decrease 147 µm, interquartile range 41.8-242.8 µm, P < 0.001). Change in VA between the baseline and most recent visit was not significant, but VFMD improved significantly after stenting (median increase 3.0, IQR 2.0-4.2, P < 0.001). No patient developed transverse sinus restenosis nor in-stent thrombosis postoperatively across a median venogram follow-up of 20.8 (11.3-49.8) weeks. In addition, no patient required subsequent surgical intervention for IIH.

Conclusions: In this cohort of patients with IIH and fulminant presentation, medication resistance, or medication intolerance, TSS was an effective and safe treatment modality. Most patients were able to stop ICP-lowering medications while demonstrating striking improvement in symptomatology and visual function.

特发性颅内高压横窦支架置入术后的视觉和药物治疗效果
背景:对于特发性颅内高压(IIH)患者来说,横窦支架植入术(TSS)是一种越来越常见的治疗方法。然而,有关 TSS 术后视觉和药物治疗效果的详细神经眼科证据却很少且不尽相同。本研究旨在描述因特发性颅内高压而接受TSS治疗的患者的视觉疗效,并确定术后可停用颅内压(ICP)降压药物的患者比例:对2016年至2022年期间接受TSS治疗的2所三级学术神经眼科医院的所有IIH患者进行回顾性病历审查。支架植入术的适应症包括药物治疗失败、药物治疗不耐受以及严重乳头水肿导致的急性视力丧失。收集了有关人口统计学、症状、视功能、药物治疗和 TSS 的数据。采用配对 Wilcoxon 秩和检验比较基线和最近一次就诊之间视力(VA)和视野平均偏差(VFMD)的变化:在 435 名 IIH 患者中,15 人(13 名女性)符合纳入标准。TSS后,10名患者停止了ICP降压药物治疗,4名患者减少了ICP降压药物治疗;1名患者在TSS前未服用ICP降压药物。支架植入术后,所有患者的症状均得到缓解或改善(10 例缓解,4 例改善,1 例在 TSS 前无症状),乳头水肿也得到缓解(11 例缓解,4 例改善)。光学相干断层扫描测量的毛细血管周围神经纤维层厚度证实了乳头水肿的缓解(中位数减少了 147 微米,四分位间范围为 41.8-242.8 微米,P < 0.001)。VA在基线和最近一次就诊之间的变化并不显著,但VFMD在支架植入术后显著改善(中位数增加3.0,IQR为2.0-4.2,P < 0.001)。在 20.8 (11.3-49.8) 周的中位静脉造影随访期间,没有患者在术后发生横窦再狭窄或支架内血栓。此外,没有患者因IIH而需要后续手术治疗:结论:在这批有暴发性表现、耐药或不耐药的 IIH 患者中,TSS 是一种有效而安全的治疗方式。大多数患者都能停用ICP降压药物,同时症状和视觉功能也有显著改善。
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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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