Transverse Sinus Stenosis in Idiopathic Intracranial Hypertension with Spontaneous Cerebrospinal Fluid Leaks: A Systematic Review and Meta-analysis of Venous Sinus Stenting Outcomes

Background: Idiopathic intracranial hypertension (IIH) has been associated with transverse sinus stenosis (TSS), leading to cerebrospinal fluid (CSF) leaks. Venous sinus stenting (VSS) has recently emerged as a therapeutic intervention for patients with TSS. Data addressing the role of stenting in patients with spontaneous CSF leaks is limited; however, there is anecdotal evidence that VSS is effective in preventing recurrence following surgical repair of CSF leak.

Objective: This systematic review aims to determine the prevalence of TSS in patients with IIH presenting with spontaneous CSF leaks, and to evaluate the success rates and complications associated with venous stenting.

Methods: A comprehensive literature search was conducted in PubMed, Embase, and Cochrane databases using PRISMA guidelines for studies published between 1990 and 2024. Studies reporting on the prevalence of TSS in IIH patients with spontaneous CSF leaks and those documenting outcomes of venous stenting were included. Data extraction focused on prevalence rates, stenting success (defined as symptomatic improvement and patency), and complications. Meta-analyses were performed using random effect models to estimate pooled prevalence rates.

Results: Twelve studies comprising a total of 310 patients met the inclusion criteria. CSF leak most commonly occurred at the level of the ethmoid (101/192, 53%), followed by sphenoid (31%), temporal (7%), frontal (6%), petrous (1.5%), and tegmen (1.5%) regions. Meta-analysis revealed a pooled prevalence of TSS with CSF leaks of 82.0% (95% CI: 72.5–91.5%, I ² = 74.91%, p < 0.001) across all anatomical sites. Bilateral TSS was found to be higher in CSF leak cases at 70.7% (95% CI: 60.8–80.6%, I ² = 0%, p = 0.305) compared to unilateral TSS at 41.8% (95% CI: −6.3 to 89.9%, I ² = 94.8%, p < 0.001). Stenting procedures in TSS cases demonstrated a high success rate in resolving CSF leaks, with a pooled success rate of 92.0% (95% CI: 85.8–98.2%, I ² = 0%, p = 0.515). Two studies looked at complications of VSS and found none.

Conclusion: Transverse sinus stenosis was highly prevalent in IIH patients with spontaneous CSF leak. Venous stenting demonstrated a high success rate in symptom relief and maintaining patency, with a relatively low complication profile. These findings highlight the importance of recognizing TSS in this patient group and support venous stenting as an effective intervention. Further research is warranted to refine patient selection criteria and optimize long-term outcomes.

Publication History

Article published online:
07 February 2025