Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Sep;32(8):1408-14.
doi: 10.3174/ajnr.A2575. Epub 2011 Jul 28.

Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions

R M Ahmed  1 , M Wilkinson, G D Parker, M J Thurtell, J Macdonald, P J McCluskey, R Allan, V Dunne, M Hanlon, B K Owler, G M Halmagyi
Affiliations

Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions

R M Ahmed et al. AJNR Am J Neuroradiol. 2011 Sep.

Abstract

Background and purpose: Transverse sinus stenosis is common in patients with IIH. While the role of transverse sinus stenosis in IIH pathogenesis remains controversial, modeling studies suggest that stent placement within a transverse sinus stenosis with a significant pressure gradient should decrease cerebral venous pressure, improve CSF resorption in the venous system, and thereby reduce intracranial (CSF) pressure, improving the symptoms of IIH and reducing papilledema. We aimed to determine if IIH could be reliably treated by stent placement in transverse sinus stenosis.

Materials and methods: We reviewed the clinical, venographic, and intracranial pressure data before and after stent placement in transverse sinus stenosis in 52 of our own patients with IIH unresponsive to maximum acceptable medical treatment, treated since 2001 and followed between 2 months and 9 years.

Results: Before stent placement, the mean superior sagittal sinus pressure was 34 mm Hg (462 mm H(2)0) with a mean transverse sinus stenosis gradient of 20 mm Hg. The mean lumbar CSF pressure before stent placement was 322 mm H(2)O. In all 52 patients, stent placement immediately eliminated the TSS pressure gradient, rapidly improved IIH symptoms, and abolished papilledema. In 6 patients, symptom relapse (headache) was associated with increased venous pressure and recurrent stenosis adjacent to the previous stent. In these cases, placement of another stent again removed the transverse sinus stenosis pressure gradient and improved symptoms. Of the 52 patients, 49 have been cured of all IIH symptoms.

Conclusions: These findings indicate a role for transverse sinus stent placement in the management of selected patients with IIH.

PubMed Disclaimer

Figures

Fig 1.
Fig 1.
A, Example of a stenosis due to extrinsic compression (long narrowed segment, arrow). B, Example of an intrinsic stenosis caused by a large arachnoid granulation (arrow). C, Example of an intrinsic stenosis caused by a septal band (arrow).
See this image and copyright information in PMC

References

    1. Owler BK, Parker G, Halmagyi GM, et al. . Cranial venous outflow obstruction and pseudotumour cerebri syndrome. Adv Tech Stand Neurosurg 2005;30:107–74 - PubMed
    1. Friedman DI, Jacobson DM. Idiopathic intracranial hypertension. J Neuroophthalmol 2004;24:138–45 - PubMed
    1. Daniels AB, Liu GT, Volpe NJ, et al. . Profiles of obesity, weight gain, and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). Am J Ophthalmol 2007;143:635–41 - PubMed
    1. Friedman DI. Medication-induced intracranial hypertension in dermatology. Am J Clin Dermatol 2005;6:29–37 - PubMed
    1. De Simone R, Ranieri A. Advancement in idiopathic intracranial hypertension pathogenesis: focus on sinus venous stenosis. Neurol Sci 2010;31:S33–39 - PubMed