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Review
. 2025 Feb 6:15910199241311626.
doi: 10.1177/15910199241311626. Online ahead of print.

Venous sinus stenting for management of spontaneous skull-base CSF leaks: A systematic review and meta-analysis

Jordan M Rasmussen  1 , Kautilya R Patel  2 , Daniel L Surdell  2 , William E Thorell  2 , Nicholas Borg  2 , Patrick J Opperman  2 , Geoffrey Casazza  3 , Anne K Maxwell  3 , Christie Barnes  3 , Samuel Pate  3 , Cindy M Schmidt  4 , Mithun G Sattur  2
Affiliations
Review

Venous sinus stenting for management of spontaneous skull-base CSF leaks: A systematic review and meta-analysis

Jordan M Rasmussen et al. Interv Neuroradiol. .

Abstract

Background: Idiopathic intracranial hypertension (IIH) is strongly associated with spontaneous skull-base cerebrospinal fluid (CSF) leaks. Venous sinus stenting (VSS) has proven effective for the treatment of IIH. Hence, its role in spontaneous skull-base CSF leaks is being explored actively.

Methods: We performed a systematic literature search across EMBASE, MEDLINE, Scopus, The Cochrane Library, and Google Scholar to identify studies reporting the use of VSS for spontaneous skull-base CSF leaks. Studies with pediatric patients, non-English articles, and nonspontaneous leaks were excluded. Failure of treatment (persistence / recurrence of CSF leak) was regarded as the primary outcome.

Results: Eight studies with 62 patients undergoing VSS for spontaneous skull-base CSF leaks were included. Mean age of the patients was 51.9 years; 87.5% were females. Obesity was highly prevalent, with a mean body mass index of 33.9 kg/m2 (4 studies). IIH was noted in 74.6% patients (7 studies). Twenty-six patients (41.9%) underwent VSS alone whereas 36 patients (58.1%) underwent surgical repair + VSS. Seven patients (11.3%) had a failure of treatment. Three failures from one study could not be definitively ascribed to either of the groups. Hence, the estimated failure rate for VSS alone ranged from 18.6% (95% CI [0.02 - 0.46]) to 26.4% (95% CI [0.11 - 0.46]), whereas that for surgical repair + VSS ranged from 5.5% (95% CI [0.00 - 0.16]) to 12.2% (95% CI [0.01 - 0.32]). Furthermore, the estimated rate for resolution of concomitant IIH-related symptoms was 88.7% (95% CI [0.75 - 0.98%]). Majority of the studies did not report any serious complications or mortality related to VSS.

Conclusion: VSS has a potential role in the management of spontaneous skull-base CSF leaks. Its exact indications as a standalone treatment versus as an adjuvant to surgical repair, and the predictors for successful treatment remain to be defined.

Keywords: Venous sinus stenting; idiopathic intracranial hypertension; intracranial pressure; spontaneous CSF leak; spontaneous skull base CSF leak; transverse sinus stenosis; transverse sinus stenting.

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Conflict of interest statement

Declaration of conflicting interestsAuthor William E. Thorell is a consultant for Progressive Neuro, Inc. Rest of the authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA 2020 flow diagram describing the screening and selection of articles for the systematic review.
Figure 2.
Figure 2.
Forest plot demonstrating proportional meta-analysis using a restricted maximum likelihood model for estimating failure rate of venous sinus stenting as a standalone therapy and as an adjuvant to surgery. Three failures from Labeyrie et al have been assigned to the VSS alone group. VSS, venous sinus stenting; CI, confidence interval.
Figure 3.
Figure 3.
Forest plot demonstrating proportional meta-analysis using a restricted maximum likelihood model for estimating failure rate of venous sinus stenting as a standalone therapy and as an adjuvant to surgery. Three failures from Labeyrie et al have been assigned to the VSS + surgical repair group. VSS, venous sinus stenting; CI, confidence interval.
See this image and copyright information in PMC

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