Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension
Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension
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DOI：
10.1136/neurintsurg-2011-010156
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发表时间：
2013-01-01
影响因子：
4.8
通讯作者：
Petersen, Bryan D.
中科院分区：
文献类型：
--
作者：
Fields, Jeremy D.;Javedani, Parisa P.;Petersen, Bryan D.
背景 腰腹分流术（LPS）、脑室腹腔分流术（VPS）和视神经鞘开窗术（ONSF）是治疗难治性特发性颅内高压（IIH）的公认手术疗法。在 IIH 合并静脉窦狭窄的患者中，硬脑膜静脉窦支架植入术已成为一种替代手术方法。方法对我院所有用于 IIH 的硬脑膜支架植入术病例进行回顾性分析。资格标准包括医学上难治性 IIH，并记录有视乳头水肿和主要静脉流出系统硬脑膜静脉窦狭窄（梯度 >= 10 mm Hg）。 结果 确定了 15 例患者（全部为女性），平均年龄为 34 岁。所有人的药物治疗均失败，其中六人的手术干预失败。所有患者都取得了技术成功，没有出现严重的围手术期并发症。静脉狭窄的平均术前梯度从术前的 24 mm Hg 降至术后的 4 mm Hg。 10 名患者的头痛得到缓解或改善。所有患者的视乳头水肿均得到缓解，14 名患者的视力稳定或提高。随访影像学检查的 14 例患者中没有出现再狭窄的情况。 结论 在这个小病例系列中，IIH 硬脑膜窦支架置入术安全地进行，技术上取得了高度成功，临床效果也很好。这些结果表明，血管成形术和支架置入术作为 LPS、VPS 和 ONSF 的替代方案，用于治疗硬脑膜窦狭窄患者难治性 IIH，值得进一步研究。
Background Lumboperitoneal shunt (LPS), ventriculoperitoneal shunt (VPS) and optic nerve sheath fenestration (ONSF) are accepted surgical therapies for medically refractory idiopathic intracranial hypertension (IIH). In the subset of patients with IIH and venous sinus stenosis, dural venous sinus stenting has emerged as an alternative surgical approach.Methods All cases of dural stents for IIH at our institution were retrospectively reviewed. Eligibility criteria included medically refractory IIH with documented papilledema and dural venous sinus stenosis of the dominant venous outflow system (gradient >= 10 mm Hg).Results Fifteen cases (all women) of mean age 34 years were identified. All had failed medical therapy and six had failed surgical intervention. Technical success was achieved in all patients without major periprocedural complications. The mean preprocedural gradient across the venous stenosis was reduced from 24 mm Hg before the procedure to 4 mm Hg after the procedure. Headache resolved or improved in 10 patients. Papilledema resolved in all patients and visual acuity stabilized or improved in 14 patients. There were no instances of restenosis among the 14 patients with follow-up imaging.Conclusion In this small case series, dural sinus stenting for IIH was performed safely with a high degree of technical success and with excellent clinical outcomes. These results suggest that angioplasty and stenting for the treatment of medically refractory IIH in patients with dural sinus stenosis warrants further investigation as an alternative to LPS, VPS and ONSF.