Assessment of Intracranial Pressure During Venous Sinus Stenting

Introduction: Elevated intracranial pressure may be due to mass effect but also obstruction of CSF outflow. This can be at the level of the Pacchionian granulations, the presumed mechanism in increased intracranial hypertension, but also due to impaired cerebral venous outflow. Multiple mechanisms have been adopted to lower intracranial pressure which has been recognized as a potential cause of irreversible optic nerve dysfunction. One of the most recent developments has been the advent of venous stenting for presumed venous outflow pathology. This may play a role in patients with idiopathic intracranial hypertension or structural venous abnormalities.

Materials and Methods: Prospective pilot study of venous stenting in patients with intracranial hypertension. Venous gradient measurements were combined with ongoing real time assessment of intracranial pressure by intracranial bolt monitoring. In a series of 11 patients, intracranial pressure and venous pressure were simultaneously monitored in patients undergoing stenting for intracranial hypertension. Quantitative assessment of optic nerve function was also included including psychophysical testing (automated static perimetry), and anatomic testing (optical coherence tomography).

Results: Immediate drop in the trans-venous gradient could be seen with demployment of venous stents associated with an immediate drop in bolt monitor intracranial hypertension. Quantitative assessment demonstrated improvement in psychophysical function with automated perimetry in those patients with active disc edema and thinning of nerve fiber layer. When the nerve fiber layer was already compromised although the anatomy did not change

Conclusion: Venous stenting represents an intriguing and evolving technology to protect optic nerve function in the setting of increased intracranial pressure.