Abstract
Idiopathic intracranial hypertension (IIH) is a disease process of abnormally increased
intracranial pressure in the absence of a mass lesion. Medical management, optic nerve
fenestration, and surgical shunting procedures have failed to produce consistently
successful results. In an unknown percentage of cases, IIH is caused by dural venous
sinus obstruction which can be cured by endovascular treatment with dural venous sinus
stent placement. This helps prevent progressive vision loss and worsening papilledema
caused by underlying increased intracranial pressure from venous outflow obstruction.
Patients are required to have an established diagnosis of IIH, preferably made by
a neuroophthalmologist, with clearly documented papilledema or at minimum visual disturbance
along with lumbar puncture opening pressure greater than 25 cm H2O. Transverse to sigmoid sinus focal narrowing (intraluminal filling defect or extrinsic
compression) must be seen during the venous phase of neuroangiography (NA) along with
a pressure gradient of 10 mm Hg or greater across the focal narrowing during dural
venous sinus pressure monitoring. A successful reduction is defined as a pressure
gradient of less than 10 mm Hg after stent placement. Neuroophthalmologic follow-up
occurs within 1 to 2 months to assess for changes in papilledema. If papilledema is
unchanged or worsened, NA and hemodynamic evaluation is repeated for consideration
of restenting. Appropriate patient selection criteria are required for IIH venous
sinus stenting. The utilization of refined endovascular techniques along with postprocedure
follow-up protocols can ultimately cure IIH for a select group of patients.
Keywords
intracranial hypertension - venous sinus obstruction - pseudotumor cerebri - interventional
radiology
