Venous Sinus Stenting for Cerebrospinal Fluid Leaks in Setting of Idiopathic Intracranial Hypertension—An Institutional Series and Systematic Review of Literature

Abstract

Introduction Chronic cerebrospinal fluid (CSF) pressure in idiopathic intracranial hypertension (IIH) can erode the skull base and cause CSF leaks, necessitating surgical repair or other interventions. Venous sinus stenting (VSS) may restore normal CSF reabsorption and flow, reducing elevated pressures and warranting further investigation as a treatment for IIH-related CSF leaks.

Methods We retrospectively reviewed charts of IIH patients who underwent VSS for CSF leak repair, analyzing clinical presentation, imaging, treatment, and follow-up. A systematic review of PubMed and Embase was conducted, with continuous variables reported as medians and interquartile ranges (IQRs).

Results We included two institutional cases and seven cases from the systematic review. Median age was 51 years (35–53), with eight female and six obese patients. Among six patients with prior confirmed IIH, four of five treated with acetazolamide were refractory. All presented with CSF rhinorrhea, six had a history of leaks, and four were recurrences. Seven had bony dehiscence. All had bilateral venous stenosis with a pressure gradient of 6 mmHg (3–8.25) and underwent unilateral VSS, with one patient also undergoing angioplasty. Over a 12-month follow-up (11–27), leaks resolved in all patients but one within 3 months (0.875–3). Four had recurrences by 7.15 months (4.8–9); one resolved spontaneously, another after angioplasty, and two required ventriculoperitoneal shunting. One patient underwent additional dural grafting for new sphenoid dehiscence, achieving resolution.

Conclusion VSS can be an effective initial treatment for IIH-related CSF leaks; but if VSS does not adequately address underlying intracranial pressures, additional medical and surgical interventions are warranted to prevent recurrent leaks.

Keywords

idiopathic intracranial hypertension - cerebrospinal fluid leak - venous sinus stenosis - venous sinus stenting - transverse sinus - systematic review

Previous Presentation

Accepted for Oral Presentation at North American Skull Base Society 33rd Annual Meeting from February 16 to 18, 2024, Atlanta, GA, United States of America.

Ethical Approval

University at Buffalo Institutional Review Board approval: STUDY00008517. The systematic review was exempt from requiring a formal protocol.

Author Contributions

The conceptualization of the project was carried out by JL, VJ, AHS, and KV. The methodology was developed by JL, VJ, HSK, CL, AF, MG, EIL, AHS, and KV. Validation involved JL, VJ, HSK, CL, AF, MG, BKO, MDM, EIL, AHS, and KV. Formal analysis was not applicable. The investigation was conducted by JL, VJ, HSK, CL, AF, MG, BKO, and MDM. Resources were provided by EIL, AHS, and KV. Data curation was done by JL, VJ, HSK, CL, AF, MG, BKO, and MDM. The original draft of the writing was composed by JL and VJ, while the review and editing were done by all the authors. Visualization was handled by JL, VJ, HSK, CL, AF, MG, BKO, MDM, EIL, AHS, and KV. Supervision was carried out by EIL, AHS, and KV. Project administration was managed by JL and VJ.

Publication History

Received: 03 November 2024

Accepted: 27 November 2024

Article published online:
26 December 2024

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