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

Nathan A. Luzum; Anthony Ghanem; Nathan Sattah; Mohammad Bilal Alsavaf; Somtochi Okafor; David Jang; Bradley Goldstein; Erik Hauck; Ralph Abi-Hachem

doi:10.1055/s-0045-1803311

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2025; 86(S 01): S1-S576
DOI: 10.1055/s-0045-1803311

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

Authors

Nathan A. Luzum

¹Duke University School of Medicine, Durham, North Carolina, United States
Anthony Ghanem

²Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
Nathan Sattah

¹Duke University School of Medicine, Durham, North Carolina, United States
Mohammad Bilal Alsavaf

³Otolaryngology—Head and Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University College of Medicine, Columbus, Ohio, United States
Somtochi Okafor

²Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
David Jang

²Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
Bradley Goldstein

²Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
Erik Hauck

⁴Department of Neurosurgery, Duke University, Durham, North Carolina, United States
Ralph Abi-Hachem

²Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States

Abstract

Full Text

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.