Intracranial hypertension induced by internal jugular vein stenosis can be resolved by stenting
Intracranial hypertension induced by internal jugular vein stenosis can be resolved by stenting
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DOI：
10.1111/ene.13512
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发表时间：
2018-02-01
影响因子：
5.1
通讯作者：
Ji, X.
中科院分区：
文献类型：
--
作者：
Zhou, D.;Meng, R.;Ji, X.
背景和目的特发性颅内高压（IIH）的特点是颅内压（ICP）异常升高，且病因不明。然而最近，在没有颅内异常的情况下，发现部分疑似IIH患者存在孤立性颈内静脉(IJV)狭窄。方法从46例疑似IIH患者中连续筛查15例患者，最终确诊为孤立性IJV狭窄。当跨狭窄平均压力梯度(MPG)等于或高于5.44 cmH(2)O时，通过支架置入术矫正狭窄的IJV。比较支架置入前后动态磁共振静脉造影、计算机断层静脉造影和数字减影血管造影的IJV、MPG、ICP、头痛冲击试验6和Frisen视乳头水肿分级评分。结果所有狭窄的IJV均经支架矫正。 MPG下降，异常侧支静脉立即消失或缩小。随访第 14-3 天，头痛、耳鸣、视乳头水肿和 ICP 均显着改善（均 P < 0.01）。在 12 +/- 5.6 个月的门诊随访中，15 名患者中有 14 名（93.3%）头痛消失，12 名患者中有 10 名（83.3%）视力障碍恢复，11 名患者中有 10 名（90.9%）耳鸣消失。 15 例中有 12 例的 Frisen 视乳头水肿分级评分降至 1 (0-2)。所有 15 名患者的支架 IJV 在 CT 静脉造影随访中均保持足够的血流量，未出现与支架相关的不良事件。结论非血栓性 IJV 狭窄可能是 IIH 的潜在病因。支架置入术似乎是从病因层面解决颅内高压问题的一个有前途的选择，特别是在药物治疗失败后。
Background and purposeIdiopathic intracranial hypertension (IIH) is characterized by abnormally elevated intracranial pressure (ICP) without identifiable etiology. Recently, however, a subset of patients with presumed IIH have been found with isolated internal jugular vein (IJV) stenosis in the absence of intracranial abnormalities.MethodsFifteen consecutive patients were screened from 46 patients suspected as IIH and were finally confirmed as isolated IJV stenosis. The stenotic IJV was corrected with stenting when the trans-stenotic mean pressure gradient (MPG) was equal to or higher than 5.44 cmH(2)O. Dynamic magnetic resonance venography, computed tomographic venography and digital subtraction angiography of the IJV, MPG, ICP, Headache Impact Test 6 and the Frisen papilledema grade score before and after stenting were compared.ResultsAll the stenotic IJVs were corrected by stenting. MPG decreased and the abnormal collateral veins disappeared or shrank immediately. Headache, tinnitus, papilledema and ICP were significantly ameliorated at 14 3 days of follow-up (all P < 0.01). At 12 +/- 5.6 months of outpatient follow-up, headache disappeared in 14 out of 15 patients (93.3%), visual impairments were recovered in 10 of 12 patients (83.3%) and tinnitus resolved in 10 out of 11 patients (90.9%). In 12 out of 15 cases, the Frisen papilledema grade scores declined to 1 (0-2). The stented IJVs in all 15 patients kept to sufficient blood flows on computed tomographic venography follow-up without stenting-related adverse events.ConclusionsNon-thrombotic IJV stenosis may be a potential etiology of IIH. Stenting seems to be a promising option to address the issue of intracranial hypertension from the etiological level, particularly after medical treatment failure.