Venous sinus stenting versus ventriculoperitoneal shunting: comparing clinical outcomes for idiopathic intracranial hypertension.

Autor:	Hilvert AM; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA austin.m.hilvert@vanderbilt.edu., Gauhar F; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Longo M; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Grimaudo H; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Dugan J; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Mummareddy N; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Chitale R; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Froehler MT; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Fusco MR; Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2024 Nov 22; Vol. 16 (12), pp. 1264-1267. Date of Electronic Publication: 2024 Nov 22.
DOI:	10.1136/jnis-2024-022174
Abstrakt:	Background: Venous sinus stenting (VSS) has been shown to reduce intracranial venous pressures and improve symptoms in patients with idiopathic intracranial hypertension (IIH). However, long-term follow-up data are limited, raising concerns about sustained symptom improvement. We aimed to assess long-term outcomes of VSS compared with ventriculoperitoneal shunting (VPS). Methods: A retrospective case-control study assessed 87 patients with IIH who met inclusion criteria and underwent either VSS (n=27) or VPS (n=60) between 2017 and 2022. Descriptive statistics for baseline characteristics and outcomes were calculated, followed by multivariate logistic regression to identify factors associated with headache recurrence. Results: Baseline characteristics were similar between VSS and VPS groups, including age (p=0.58), sex (p=0.74), body mass index (p=0.47), and preoperative lumbar puncture opening pressure (p=0.62). Preoperative symptoms of headaches (p=0.42), papilledema (p=0.35), and pulsatile tinnitus (p=0.56) were also similar. Initial headache improvement was comparable (96% vs 91%, p=0.42). However, headache recurrence was less common in the VSS group (31% vs 60%, p=0.015) at the last follow-up, averaging over 1 year. Multivariate analysis showed VSS was independently associated with reduced odds of headache recurrence (OR 0.24, p=0.015). Longer follow-up was associated with increased odds of headache recurrence in both groups (OR 1.01, p=0.032). Conclusion: VSS was independently associated with reduced odds of headache recurrence compared with VPS in multivariate analysis. Longer follow-up was significantly associated with headache recurrence in both groups. This suggests that VSS may lead to better outcomes for continued headache relief, but headache recurrence may increase with longer follow-up regardless of treatment modality. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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