Redefining treatment expectations: exploring mid- and long-term outcomes of venous sinus stenting in idiopathic intracranial hypertension.

Autor: Midtlien JP; Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA jmidtlie@wakehealth.edu., Kittel C; Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA., Klever LA; Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA., Kiritsis NR; Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA., Aldridge JB; Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA., Fargen KM; Department of Neurological Surgery, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
Jazyk: angličtina
Zdroj: Journal of neurointerventional surgery [J Neurointerv Surg] 2024 Mar 07. Date of Electronic Publication: 2024 Mar 07.
DOI: 10.1136/jnis-2023-021336
Abstrakt: Background: Venous sinus stenting (VSS) is recognized as a safe and effective intervention for medically-refractory idiopathic intracranial hypertension (IIH). However, its long-term efficacy remains uncertain.
Methods: This retrospective review analyzed a single-center database of adult patients with severe, medically-refractory IIH, who underwent VSS and had minimum 3-month follow-up (FU). Patients were divided into three groups based on post-stenting symptom trajectories: group 1 (sustained improvement without relapse), group 2 (temporary improvement with relapse), and group 3 (no improvement).
Results: Of 178 patients undergoing VSS, the majority were female (94%), with a median opening pressure (OP) of 31 cm H 2 O and trans-stenosis gradient of 14 mm Hg. Of these, 153 (86%) received transverse sinus (TS) stenting, and 19 (11%) underwent concurrent TS and superior sagittal sinus stenting. At a mean FU of 166 days, 53 patients (30%) showed long-term improvement without relapse (group 1). Symptomatic recurrence was noted in 101 patients (57%; group 2) within a mean FU of 390 days. Despite recurrent headache and tinnitus, the average OP reduction was 9.6 cm H 2 O on repeat lumbar puncture, with 75% showing papilledema improvement or resolution post-VSS. Only 17% required further surgical intervention.
Conclusions: The most common clinical outcome post-VSS in IIH patients is initial symptomatic improvement followed by symptom recurrence in about 60% at a mean of 274 days, despite a consistent intracranial pressure reduction. These findings can guide physicians in setting realistic expectations with patients regarding VSS outcomes.
Competing Interests: Competing interests: KMF serves on the editorial board of JNIS.
(© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
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