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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2003 Dec;74(12):1662–1666. doi: 10.1136/jnnp.74.12.1662

Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting

J Higgins 1, C Cousins 1, B Owler 1, N Sarkies 1, J Pickard 1
PMCID: PMC1757418  PMID: 14638886

Abstract

Background: The high pressures documented in the intracranial venous sinuses in idiopathic intracranial hypertension (IIH) could be the result of focal stenotic lesions in the lateral sinuses obstructing cranial venous outflow.

Objective: To explore the relation between venous sinus disease and IIH.

Methods: 12 patients with refractory IIH had dilatation and stenting of the venous sinuses after venography and manometry had shown intracranial venous hypertension proximal to stenoses in the lateral sinuses. Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome.

Results: Intrasinus pressures were variably reduced by stenting. Five patients were rendered asymptomatic, two were improved, and five were unchanged.

Conclusions: The importance of venous sinus disease in the aetiology of IIH is probably underestimated. Lateral sinus stenting shows promise as an alternative treatment to neurosurgical intervention in intractable cases.

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Selected References

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  1. A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. The Vagus Nerve Stimulation Study Group. Neurology. 1995 Feb;45(2):224–230. doi: 10.1212/wnl.45.2.224. [DOI] [PubMed] [Google Scholar]
  2. Ayanzen R. H., Bird C. R., Keller P. J., McCully F. J., Theobald M. R., Heiserman J. E. Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am J Neuroradiol. 2000 Jan;21(1):74–78. [PMC free article] [PubMed] [Google Scholar]
  3. Biousse V., Ameri A., Bousser M. G. Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology. 1999 Oct 22;53(7):1537–1542. doi: 10.1212/wnl.53.7.1537. [DOI] [PubMed] [Google Scholar]
  4. Czosnyka M., Whitehouse H., Smielewski P., Simac S., Pickard J. D. Testing of cerebrospinal compensatory reserve in shunted and non-shunted patients: a guide to interpretation based on an observational study. J Neurol Neurosurg Psychiatry. 1996 May;60(5):549–558. doi: 10.1136/jnnp.60.5.549. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Donaldson J. O. Pathogenesis of pseudotumor cerebri syndromes. Neurology. 1981 Jul;31(7):877–880. doi: 10.1212/wnl.31.7.877. [DOI] [PubMed] [Google Scholar]
  6. Fishman R. A. The pathophysiology of pseudotumor cerebri. An unsolved puzzle. Arch Neurol. 1984 Mar;41(3):257–258. doi: 10.1001/archneur.1984.04050150035011. [DOI] [PubMed] [Google Scholar]
  7. Higgins J. Nicholas P., Owler Brian K., Cousins Claire, Pickard John D. Venous sinus stenting for refractory benign intracranial hypertension. Lancet. 2002 Jan 19;359(9302):228–230. doi: 10.1016/S0140-6736(02)07440-8. [DOI] [PubMed] [Google Scholar]
  8. Janny P., Chazal J., Colnet G., Irthum B., Georget A. M. Benign intracranial hypertension and disorders of CSF absorption. Surg Neurol. 1981 Mar;15(3):168–174. doi: 10.1016/0090-3019(81)90131-2. [DOI] [PubMed] [Google Scholar]
  9. Johnston I. H., Rowan J. O. Raised intracranial pressure and cerebral blood flow. 3. Venous outflow tract pressures and vascular resistances in experimental intracranial hypertension. J Neurol Neurosurg Psychiatry. 1974 Apr;37(4):392–402. doi: 10.1136/jnnp.37.4.392. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Karahalios D. G., Rekate H. L., Khayata M. H., Apostolides P. J. Elevated intracranial venous pressure as a universal mechanism in pseudotumor cerebri of varying etiologies. Neurology. 1996 Jan;46(1):198–202. doi: 10.1212/wnl.46.1.198. [DOI] [PubMed] [Google Scholar]
  11. King J. O., Mitchell P. J., Thomson K. R., Tress B. M. Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology. 2002 Jan 8;58(1):26–30. doi: 10.1212/wnl.58.1.26. [DOI] [PubMed] [Google Scholar]
  12. Lee A. G., Brazis P. W. Magnetic resonance venography in idiopathic pseudotumor cerebri. J Neuroophthalmol. 2000 Mar;20(1):12–13. doi: 10.1097/00041327-200020010-00004. [DOI] [PubMed] [Google Scholar]
  13. Medlock M. D., Olivero W. C., Hanigan W. C., Wright R. M., Winek S. J. Children with cerebral venous thrombosis diagnosed with magnetic resonance imaging and magnetic resonance angiography. Neurosurgery. 1992 Nov;31(5):870–876. doi: 10.1227/00006123-199211000-00007. [DOI] [PubMed] [Google Scholar]
  14. Osterholm J. L. Reaction of the cerebral venous sinus system to acute intracranial hypertension. J Neurosurg. 1970 Jun;32(6):654–659. doi: 10.3171/jns.1970.32.6.0654. [DOI] [PubMed] [Google Scholar]
  15. RAY B. S., DUNBAR H. S. Thrombosis of the dural venous sinuses as a cause of pseudotumor cerebri. Ann Surg. 1951 Sep;134(3):376–386. doi: 10.1097/00000658-195113430-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Schürmann Karl, Mahnken Andreas, Meyer Julius, Haage Patrick, Chalabi Khaled, Peters Ilse, Günther Rolf W., Vorwerk Dierk. Long-term results 10 years after iliac arterial stent placement. Radiology. 2002 Sep;224(3):731–738. doi: 10.1148/radiol.2242011101. [DOI] [PubMed] [Google Scholar]
  17. Siskin Gary P., Englander Meridith, Roddy Sean, Dowling Kyran, Dolen Eric G., Quarfordt Steven, Hughes Terence, Mandato Kenneth. Results of iliac artery stent placement in patients younger than 50 years of age. J Vasc Interv Radiol. 2002 Aug;13(8):785–790. doi: 10.1016/s1051-0443(07)61986-1. [DOI] [PubMed] [Google Scholar]
  18. Sussman J. D., Sarkies N., Pickard J. D. Benign intracranial hypertension. Pseudotumour cerebri: idiopathic intracranial hypertension. Adv Tech Stand Neurosurg. 1998;24:261–305. [PubMed] [Google Scholar]
  19. Vogl T. J., Bergman C., Villringer A., Einhäupl K., Lissner J., Felix R. Dural sinus thrombosis: value of venous MR angiography for diagnosis and follow-up. AJR Am J Roentgenol. 1994 May;162(5):1191–1198. doi: 10.2214/ajr.162.5.8166009. [DOI] [PubMed] [Google Scholar]

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