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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2024; 43(04): e251-e257
DOI: 10.1055/s-0044-1793956
Original Article

Endovascular Treatment of Idiopathic Intracranial Hypertension Secondary to Venous Stenosis

Tratamento endovascular da Hipertensão Intracraniana Idiopática Secundária à Estenose Venosa
Leandro José Haas
1   Santa Isabel Hospital, Blumenau, SC, Brazil
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
,
Wesley Severino
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
,
Guilherme Wandall 
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
,
Wallace Mees
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
,
Gabriela Scheidt
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
,
Bernardo Przysiezny
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
,
Amanda Zimmermann
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
,
Guilherme Staedele
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
,
Bruno Rafael Sabel
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
,
Júlia Martins
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
,
Julia Dumes Hessmann
2   Medical School, University of Blumenau, Blumenau, SC, Brazil
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Abstract

Introduction Idiopathic intracranial hypertension (IIH) is a condition characterized by signs and symptoms of elevated intracranial pressure (ICP). Although the role of venous sinus stenosis in the pathophysiology of IIH is controversial, venous angioplasty with stenting has been proven to decrease cerebral venous pressure and intracranial pressure. This study aims to identify and quantify the clinical improvement obtained by patients with IIH, refractory to prior pharmacological treatment, undergoing endovascular venous angioplasty in a neuroendovascular reference service.

Methods A retrospective analytical study of 25 cases of IIH with transverse sinus stenosis operated on in a reference service using the endovascular method, in which clinical data from medical records and information about the procedure were analyzed.

Results Of the 25 patients, 22 were women, and the mean age was 42 years. All patients were refractory to prior clinical treatment. At the clinical presentation, all had headaches. There were no complications or failures from the procedures performed. In the 30-day evaluation, there was a significant decrease in all the symptoms reported.

Conclusion Venous sinus stenting is safe and effective in patients with IIH with transverse sinus stenosis refractory to clinical treatment, with substantial symptomatic improvement and good evolution in the postoperative follow-up period.

Resumo

Introdução A hipertensão intracraniana idiopática (HII) é uma condição caracterizada por sinais e sintomas de pressão intracraniana elevada (PIC). Embora o papel da estenose dos seios venosos na fisiopatologia da HII seja controverso, a angioplastia venosa com colocação de stent tem se mostrado eficaz na redução da pressão venosa cerebral e da pressão intracraniana. Este estudo visa identificar e quantificar a melhoria clínica obtida por pacientes com HII, refratários ao tratamento farmacológico prévio, submetidos à angioplastia venosa endovascular em um serviço de referência neuroendovascular.

Métodos Um estudo analítico retrospectivo de 25 casos de HII com estenose do seio transverso operados em um serviço de referência utilizando o método endovascular, no qual foram analisados dados clínicos dos prontuários médicos e informações sobre o procedimento. Resultados: Dos 25 pacientes, 22 eram mulheres, com idade média de 42 anos. Todos os pacientes eram refratários ao tratamento clínico prévio. Na apresentação clínica, todos tinham cefaleia. Não houve complicações ou falhas nos procedimentos realizados. Na avaliação de 30 dias, houve uma diminuição significativa em todos os sintomas relatados.

Conclusão A colocação de stent nos seios venosos mostrou-se segura e eficaz em pacientes com HII com estenose do seio transverso refratários ao tratamento clínico, com melhoria sintomática substancial e boa evolução no período de acompanhamento pós-operatório.

Keywords

stenosis - endovascular - idiopathic intracranial hypertension

Palavras-chave

estenose - endovascular - hipertensão intracraniana idiopática


Publication History

Received: 05 June 2024

Accepted: 18 October 2024

Article published online:
11 December 2024

© 2024. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Smith SV, Friedman DI. The Idiopathic Intracranial Hypertension Treatment Trial: A Review of the Outcomes. Headache 2017; 57 (08) 1303-1310 . Doi: 10.1111/head.13144 Erratum in: Headache. 2018 Nov;58(10):1697. PMID: 28758206
    CrossrefPubMedSearch in Google Scholar
  • 2 Mollan SP, Davies B, Silver NC. et al. Idiopathic intracranial hypertension: consensus guidelines on management. J Neurol Neurosurg Psychiatry 2018; 89 (10) 1088-1100 . Doi: 10.1136/jnnp-2017-317440
    CrossrefPubMedSearch in Google Scholar
  • 3 Miyachi S, Hiramatsu R, Ohnishi H, Takahashi K, Kuroiwa T. Endovascular Treatment of Idiopathic Intracranial Hypertension with Stenting of the Transverse Sinus Stenosis. Neurointervention 2018; 13 (02) 138-143 . Doi: 10.5469/neuroint.2018.00990
    CrossrefPubMedSearch in Google Scholar
  • 4 Daggubati LC, Liu KC. Intracranial Venous Sinus Stenting: A Review of Idiopathic Intracranial Hypertension and Expanding Indications. Cureus 2019; 11 (02) e4008 . Doi: 10.7759/cureus.4008
    PubMedSearch in Google Scholar
  • 5 Gurney SP, Ramalingam S, Thomas A, Sinclair AJ, Mollan SP. Exploring The Current Management Idiopathic Intracranial Hypertension, And Understanding The Role Of Dural Venous Sinus Stenting. Eye Brain 2020; 12: 1-13 . Doi: 10.2147/EB.S193027
    CrossrefPubMedSearch in Google Scholar
  • 6 Farb RI, Vanek I, Scott JN. et al. Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 2003; 60 (09) 1418-1424 . Doi: 10.1212/01.wnl.0000066683.34093.e2
    CrossrefPubMedSearch in Google Scholar
  • 7 Dinkin MJ, Patsalides A. Venous Sinus Stenting in Idiopathic Intracranial Hypertension: Results of a Prospective Trial. J Neuroophthalmol 2017; 37 (02) 113-121 . Doi: 10.1097/wno.0000000000000426
    CrossrefPubMedSearch in Google Scholar
  • 8 Shields LBE, Shields CB, Yao TL, Plato BM, Zhang YP, Dashti SR. Endovascular Treatment for Venous Sinus Stenosis in Idiopathic Intracranial Hypertension: An Observational Study of Clinical Indications, Surgical Technique, and Long-Term Outcomes. World Neurosurg 2019; 121: e165-e171 . Doi: 10.1016/j.wneu.2018.09.070
    CrossrefPubMedSearch in Google Scholar
  • 9 McCluskey G, Doherty-Allan R, McCarron P. et al. Meta-analysis and systematic review of population-based epidemiological studies in idiopathic intracranial hypertension. Eur J Neurol 2018; 25 (10) 1218-1227 . Doi: 10.1111/ene.13739
    CrossrefPubMedSearch in Google Scholar
  • 10 Silva J, Conti M, Aguiar G, Jory M, Monzillo P, Veiga J. Endovascular treatment for idiopathic intracranial hypertension improves clinical symptoms and signs. ArquivosBrasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36: 01-06 . Doi: 10.1055/s-0036-1597820
    PubMedSearch in Google Scholar
  • 11 Markey KA, Mollan SP, Jensen RH, Sinclair AJ. Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol 2016; 15 (01) 78-91 . Doi: 10.1016/S1474-4422(15)00298-7
    CrossrefPubMedSearch in Google Scholar
  • 12 Takkar A, Lal V. Idiopathic Intracranial Hypertension: The Monster Within. Ann Indian Acad Neurol 2020; 23 (02) 159-166 . Doi: 10.4103/aian.AIAN_190_19
    CrossrefPubMedSearch in Google Scholar
  • 13 Piper RJ, Kalyvas AV, Young AM, Hughes MA, Jamjoom AA, Fouyas IP. Interventions for idiopathic intracranial hypertension. Cochrane Database Syst Rev 2015; 2015 (08) CD003434 . Doi: 10.1002/14651858.CD003434.pub3
    PubMedSearch in Google Scholar
  • 14 Saber H, Lewis W, Sadeghi M, Rajah G, Narayanan S. Stent Survival and Stent-Adjacent Stenosis Rates following Venous Sinus Stenting for Idiopathic Intracranial Hypertension: A Systematic Review and Meta-Analysis. Intervent Neurol 2018; 7 (06) 490-500 . Doi: 10.1159/000490578
    CrossrefPubMedSearch in Google Scholar
  • 15 Starke RM, Wang T, Ding D. et al. Endovascular Treatment of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension: Complications, Neurological Outcomes, and Radiographic Results. ScientificWorldJournal 2015; 2015: 140408 . Doi: 10.1155/2015/140408
    CrossrefPubMedSearch in Google Scholar
  • 16 Cappuzzo JM, Hess RM, Morrison JF. et al. Transverse venous stenting for the treatment of idiopathic intracranial hypertension, or pseudotumor cerebri. Neurosurg Focus 2018; 45 (01) E11 . Doi: 10.3171/2018.5.FOCUS18102
    CrossrefPubMedSearch in Google Scholar