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Steven A Newman; Quantitative Assessment of Venous Stenting in IIH. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3541.
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Idiopathic intracranial hypertension (IIH) may cause transient or permanent visual system damage. In patients nonresponsive to weight reduction or medical therapy, CSF diversion procedures (subtemporal decompression, lumboperitoneal and ventriculoperitoneal shunts) can be are successful in lowering intracranial pressure. More recently, there has been an increased interest in venous pressure in the development of an IIH picture (sleep apnea, etc.). Small case series of balloon venoplasty and subsequently venous stenting have been reported to improve outcome in IIH. Although there have been “good” technical and clinical responses, the physiology of the stenting remains largely unexplored.
This is a pilot study for an ongoing prospective study of venous stenting in IIH patients. Two patients were evaluated preoperatively, intraoperatively, and post operatively with an intracranial bolt monitor in place. The patients had evidence of increased intracranial pressure, papilledema, and optic neuropathy with arcuate visual field defects.
On venography, both patients demonstrated significant gradient across narrowed portions of the transverse and sigmoid sinuses. This gradient was immediately reduced by deployment of venous stenting. Correspondingly intracranial pressure measured by continuous ICP monitoring showed immediate reduction in pressure. Patients showed subsequent quantitative improvement in their clinical signs and findings.
Although venous stenosis may represent epi-phenomena secondary to increased intracranial pressure, in at least some patients, resolution of the transvenous pressure gradient with stenting may result in decrease in intracranial pressure. The exact role of stenting remains to be determined with a larger series and quantitative assessment. The drop in intracranial pressure may be accompanied by decrease in disc edema and improvement in visual function.
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