ENDOVASCULAR TREATMENT OF IDIOPATHIC INTRACRANIAL HYPERTENSION

Abstract

BACKGROUND: Idiopathic intracranial hypertension (IIH) causes increased intracranial pressure without a mass lesion or hydrocephalus. It is caused by venous sinus obstruction in an unknown percentage of cases. In these cases, high intracranial venous sinus pressures appears to be the result of a focal venous sinus lesion causing partial or complete obstruction to cranial venous outflow. CASE DESCRIPTION: We describe an alternative treatment of venous sinus obstruction using angioplasty and stenting in a young, obese woman with refractory idiopathic intracranial hypertension. Magnetic resonance venography (MRV) was suggestive of Transverse sinus stenosis, which was confirmed by venography and manometry that showed raised pressures across the venous stenosis. A self-expanding stent was deployed across the venous stenosis immediately reducing the pressure gradient, with a striking clinical improvement. CONCLUSIONS: Angioplasty and stent placement should be considered as a treatment option to refractory idiopathic intracranial hypertension associated with dural sinus stenosis. The longterm effectiveness of sinus stenting in IIH seems to be good, but still remains uncertain. Key Words: Idiopathic intracranial hypertension; venous sinus obstruction; stenting; endovascular treatment