Download PDF
Semin Neurol 2019; 39(06): 692-703
DOI: 10.1055/s-0039-3399506
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Men Are from Mars, Idiopathic Intracranial Hypertension Is from Venous: The Role of Venous Sinus Stenosis and Stenting in Idiopathic Intracranial Hypertension

Marc Dinkin
1   Department of Neurology, Weill Cornell Medical College, New York Presbyterian Hospital, New York
2   Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York
,
Cristiano Oliveira
2   Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
17 December 2019 (online)

    Permissions and Reprints

Abstract

Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a disease primarily affecting obese women of child-bearing age, typically presenting with positional headaches, diplopia from abducens nerve palsies, pulse-synchronous tinnitus, and visual disturbances related to papilledema, including transient visual obscurations, blurry vision, and visual field defects. Controversy remains regarding the pathophysiology of IIH. Elevated intracranial pressure in IIH is thought to be the result of a dysregulation of cerebrospinal fluid (CSF) dynamics, through excessive secretion, reduced drainage, or both. Passive CSF drainage through the arachnoid granulations depends on a pressure gradient between the subarachnoid space and the cerebral venous system, such that elevations in cerebral venous pressure lead to impaired CSF drainage. Dural venous sinus stenosis (DVSS) at the junction of the transverse and sigmoid sinuses, leading to local venous hypertension and a secondary reduction in CSF drainage through the arachnoid granulations, is increasingly recognized as an important component of the pathophysiology of IIH. A growing number of studies have demonstrated a role for stenting of DVSS as an alternative to CSF shunting and optic nerve sheath fenestration in medically refractory IIH patients with vision loss or debilitating symptoms.

Keywords

idiopathic intracranial hypertension - venous sinus stenosis - dural venous sinus stenosis - venous sinus stenting
 

  • References

  • 1 Quincke H. Über Meningitis Serosa. Sammlung Klin Vor (Innere Medezin 23). 1893 ;67:655–694
    PubMedGoogle Scholar
  • 2 King JO, Mitchell PJ, Thomson KR, Tress BM. Cerebral venography and manometry in idiopathic intracranial hypertension. Neurology 1995; 45 (12) 2224-2228
    CrossrefPubMedGoogle Scholar
  • 3 Farb RI, Vanek I, Scott JN. , et al. Idiopathic Intracranial Hypertension The Prevalence and Morphology of Sinovenous Stenosis. 2003 . Available at: www.neurology.org . Accessed September 20, 2019
    PubMedGoogle Scholar
  • 4 Cheng Y, Li WA, Fan X. , et al. Normal anatomy and variations in the confluence of sinuses using digital subtraction angiography. Neurol Res 2017; 39 (06) 509-515
    CrossrefPubMedGoogle Scholar
  • 5 Riggeal BD, Bruce BB, Saindane AM. , et al. Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology 2013; 80 (03) 289-295
    CrossrefPubMedGoogle Scholar
  • 6 Ahmed RM, Wilkinson M, Parker GD. , et al. Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. AJNR Am J Neuroradiol 2011; 32 (08) 1408-1414
    CrossrefPubMedGoogle Scholar
  • 7 Rohr A, Dörner L, Stingele R, Buhl R, Alfke K, Jansen O. Reversibility of venous sinus obstruction in idiopathic intracranial hypertension. AJNR Am J Neuroradiol 2007; 28 (04) 656-659
    PubMedGoogle Scholar
  • 8 McCormick MW, Bartels HG, Rodriguez A, Johnson JE, Janjua RM. Anatomical variations of the transverse-sigmoid sinus junction: implications for endovascular treatment of idiopathic intracranial hypertension. Anat Rec (Hoboken) 2016; 299 (08) 1037-1042
    CrossrefPubMedGoogle Scholar
  • 9 Strydom MA, Briers N, Bosman MC, Steyn S. The anatomical basis of venographic filling defects of the transverse sinus. Clin Anat 2010; 23 (02) 153-159
    PubMedGoogle Scholar
  • 10 Lenck S, Vallée F, Labeyrie MA. , et al. Stenting of the lateral sinus in idiopathic intracranial hypertension according to the type of stenosis. Neurosurgery 2017; 80 (03) 393-400
    CrossrefPubMedGoogle Scholar
  • 11 Pollay M. The function and structure of the cerebrospinal fluid outflow system. Cerebrospinal Fluid Res 2010; 7 (01) 9
    CrossrefPubMedGoogle Scholar
  • 12 Lazzaro MA, Darkhabani Z, Remler BF. , et al. Venous sinus pulsatility and the potential role of dural incompetence in idiopathic intracranial hypertension. Neurosurgery 2012; 71 (04) 877-883
    CrossrefPubMedGoogle Scholar
  • 13 Absinta M, Ha S-K, Nair G. , et al. Human and nonhuman primate meninges harbor lymphatic vessels that can be visualized noninvasively by MRI. eLife 2017; 6: e29738
    CrossrefPubMedGoogle Scholar
  • 14 Louveau A, Smirnov I, Keyes TJ. , et al. Structural and functional features of central nervous system lymphatic vessels. Nature 2015; 523 (7560): 337-341
    CrossrefPubMedGoogle Scholar
  • 15 Aspelund A, Antila S, Proulx ST. , et al. A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules. J Exp Med 2015; 212 (07) 991-999
    CrossrefPubMedGoogle Scholar
  • 16 Iliff JJ, Wang M, Liao Y. , et al. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β. Sci Transl Med 2012; 4 (147) 147ra111
    PubMedGoogle Scholar
  • 17 Lenck S, Radovanovic I, Nicholson P, Hodaie M, Krings T, Mendes-Pereira V. Idiopathic intracranial hypertension: the veno glymphatic connections. Neurology 2018; 91 (11) 515-522
    CrossrefPubMedGoogle Scholar
  • 18 Alperin N, Ranganathan S, Bagci AM. , et al. MRI evidence of impaired CSF homeostasis in obesity-associated idiopathic intracranial hypertension. AJNR Am J Neuroradiol 2013; 34 (01) 29-34
    CrossrefPubMedGoogle Scholar
  • 19 Hedjoudje A, Piveteau A, Gonzalez-Campo C, Moghekar A, Gailloud P, San Millán D. The occipital emissary vein: a possible marker for pseudotumor cerebri. AJNR Am J Neuroradiol 2019; 40 (06) 973-978
    CrossrefPubMedGoogle Scholar
  • 20 Higgins JNP, Cousins C, Owler BK, Sarkies N, Pickard JD. Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry 2003; 74 (12) 1662-1666
    CrossrefPubMedGoogle Scholar
  • 21 King JO, Mitchell PJ, Thomson KR, Tress BM. Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology 2002; 58 (01) 26-30
    CrossrefPubMedGoogle Scholar
  • 22 Higgins JNP, Owler BK, Cousins C, Pickard JD. Venous sinus stenting for refractory benign intracranial hypertension. Lancet 2002; 359 (9302): 228-230
    CrossrefPubMedGoogle Scholar
  • 23 Asif H, Craven CL, Siddiqui AH. , et al. Idiopathic intracranial hypertension: 120-day clinical, radiological, and manometric outcomes after stent insertion into the dural venous sinus. J Neurosurg 2018; 129 (03) 723-731
    CrossrefPubMedGoogle Scholar
  • 24 Levitt MR, Hlubek RJ, Moon K. , et al. Incidence and predictors of dural venous sinus pressure gradient in idiopathic intracranial hypertension and non-idiopathic intracranial hypertension headache patients: results from 164 cerebral venograms. J Neurosurg 2017; 126 (02) 347-353
    CrossrefPubMedGoogle Scholar
  • 25 Levitt MR, McGah PM, Moon K. , et al. Computational modeling of venous sinus stenosis in idiopathic intracranial hypertension. AJNR Am J Neuroradiol 2016; 37 (10) 1876-1882
    CrossrefPubMedGoogle Scholar
  • 26 Fargen KM, Liu K, Garner RM, Greeneway GP, Wolfe SQ, Crowley RW. Recommendations for the selection and treatment of patients with idiopathic intracranial hypertension for venous sinus stenting. J Neurointerv Surg 2018; 10 (12) 1203-1208
    CrossrefPubMedGoogle Scholar
  • 27 Aguilar-Pérez M, Martinez-Moreno R, Kurre W. , et al. Endovascular treatment of idiopathic intracranial hypertension: retrospective analysis of immediate and long-term results in 51 patients. Neuroradiology 2017; 59 (03) 277-287
    CrossrefPubMedGoogle Scholar
  • 28 Ahmed R, Friedman DI, Halmagyi GM. Stenting of the transverse sinuses in idiopathic intracranial hypertension. J Neuroophthalmol 2011; 31 (04) 374-380
    CrossrefPubMedGoogle Scholar
  • 29 Albuquerque FC, Dashti SR, Hu YC. , et al. Intracranial venous sinus stenting for benign intracranial hypertension: clinical indications, technique, and preliminary results. World Neurosurg 2011; 75 (5-6): 648-652 , discussion 592–595
    CrossrefPubMedGoogle Scholar
  • 30 Arac A, Lee M, Steinberg GK, Marcellus M, Marks MP. Efficacy of endovascular stenting in dural venous sinus stenosis for the treatment of idiopathic intracranial hypertension. Neurosurg Focus 2009; 27 (05) E14
    PubMedGoogle Scholar
  • 31 Bussière M, Falero R, Nicolle D, Proulx A, Patel V, Pelz D. Unilateral transverse sinus stenting of patients with idiopathic intracranial hypertension. AJNR Am J Neuroradiol 2010; 31 (04) 645-650
    CrossrefPubMedGoogle Scholar
  • 32 Cappuzzo JM, Hess RM, Morrison JF. , et al. Transverse venous stenting for the treatment of idiopathic intracranial hypertension, or pseudotumor cerebri. Neurosurg Focus 2018; 45 (01) E11
    PubMedGoogle Scholar
  • 33 Crosa R, Marabotto O, Meehroff G. , et al. Pseudotumor cerebri: a new door opens for treatment. Interv Neuroradiol 2007; 13 (02) 145-151
    PubMedGoogle Scholar
  • 34 Dinkin MJ, Patsalides A. Venous sinus stenting in idiopathic intracranial hypertension: results of a prospective trial. J Neuroophthalmol 2017; 37 (02) 113-121
    CrossrefPubMedGoogle Scholar
  • 35 Donnet A, Metellus P, Levrier O. , et al. Endovascular treatment of idiopathic intracranial hypertension: clinical and radiologic outcome of 10 consecutive patients. Neurology 2008; 70 (08) 641-647
    CrossrefPubMedGoogle Scholar
  • 36 Ducruet AF, Crowley RW, McDougall CG, Albuquerque FC. Long-term patency of venous sinus stents for idiopathic intracranial hypertension. J Neurointerv Surg 2014; 6 (03) 238-242
    CrossrefPubMedGoogle Scholar
  • 37 El Mekabaty A, Obuchowski NA, Luciano MG. , et al. Predictors for venous sinus stent retreatment in patients with idiopathic intracranial hypertension. J Neurointerv Surg 2017; 9 (12) 1228-1232
    CrossrefPubMedGoogle Scholar
  • 38 Elder BD, Goodwin CR, Kosztowski TA. , et al. Venous sinus stenting is a valuable treatment for fulminant idiopathic intracranial hypertension. J Clin Neurosci 2015; 22 (04) 685-689
    CrossrefPubMedGoogle Scholar
  • 39 Fargen KM, Velat GJ, Lewis SB, Hoh BL, Mocco J, Lawson MF. Concomitant intracranial pressure monitoring during venous sinus stenting for intracranial hypertension secondary to venous sinus stenosis. J Neurointerv Surg 2013; 5 (04) e22
    CrossrefPubMedGoogle Scholar
  • 40 Fields JD, Javedani PP, Falardeau J. , et al. Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension. J Neurointerv Surg 2013; 5 (01) 62-68
    CrossrefPubMedGoogle Scholar
  • 41 He CZ, Ji XM, Wang LJ. , et al. [Endovascular treatment for venous sinus stenosis in idiopathic intracranial hypertension]. Zhonghua Yi Xue Za Zhi 2012; 92 (11) 748-751
    PubMedGoogle Scholar
  • 42 Koovor JM, Lopez GV, Riley K, Tejada J. Transverse venous sinus stenting for idiopathic intracranial hypertension: safety and feasibility. Neuroradiol J 2018; 31 (05) 513-517
    CrossrefPubMedGoogle Scholar
  • 43 Kumpe DA, Seinfeld J, Huang X. , et al. Dural sinus stenting for idiopathic intracranial hypertension: factors associated with hemodynamic failure and management with extended stenting. J Neurointerv Surg 2017; 9 (09) 867-874
    CrossrefPubMedGoogle Scholar
  • 44 Kumpe DA, Bennett JL, Seinfeld J, Pelak VS, Chawla A, Tierney M. Dural sinus stent placement for idiopathic intracranial hypertension. J Neurosurg 2012; 116 (03) 538-548
    CrossrefPubMedGoogle Scholar
  • 45 Liu KC, Starke RM, Durst CR. , et al. Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study. J Neurosurg 2017; 127 (05) 1126-1133
    CrossrefPubMedGoogle Scholar
  • 46 Liu X, Di H, Wang J. , et al. Endovascular stenting for idiopathic intracranial hypertension with venous sinus stenosis. Brain Behav 2019; 9 (05) e01279
    CrossrefPubMedGoogle Scholar
  • 47 Matloob SA, Toma AK, Thompson SD. , et al. Effect of venous stenting on intracranial pressure in idiopathic intracranial hypertension. Acta Neurochir (Wien) 2017; 159 (08) 1429-1437
    CrossrefPubMedGoogle Scholar
  • 48 Miyachi S, Hiramatsu R, Ohnishi H, Takahashi K, Kuroiwa T. Endovascular treatment of idiopathic intracranial hypertension with stenting of the transverse sinus stenosis. Neurointervention 2018; 13 (02) 138-143
    CrossrefPubMedGoogle Scholar
  • 49 Ogungbo B, Roy D, Gholkar A, Mendelow AD. Endovascular stenting of the transverse sinus in a patient presenting with benign intracranial hypertension. Br J Neurosurg 2003; 17 (06) 565-568
    CrossrefPubMedGoogle Scholar
  • 50 Paquet C, Poupardin M, Boissonnot M, Neau JP, Drouineau J. Efficacy of unilateral stenting in idiopathic intracranial hypertension with bilateral venous sinus stenosis: a case report. Eur Neurol 2008; 60 (01) 47-48
    CrossrefPubMedGoogle Scholar
  • 51 Patsalides A, Oliveira C, Wilcox J. , et al. Venous sinus stenting lowers the intracranial pressure in patients with idiopathic intracranial hypertension. J Neurointerv Surg 2019; 11 (02) 175-178
    CrossrefPubMedGoogle Scholar
  • 52 Radvany MG, Solomon D, Nijjar S. , et al. Visual and neurological outcomes following endovascular stenting for pseudotumor cerebri associated with transverse sinus stenosis. J Neuroophthalmol 2013; 33 (02) 117-122
    CrossrefPubMedGoogle Scholar
  • 53 Rajpal S, Niemann DB, Turk AS. Transverse venous sinus stent placement as treatment for benign intracranial hypertension in a young male: case report and review of the literature. J Neurosurg 2005; 102 (3, Suppl): 342-346
    CrossrefPubMedGoogle Scholar
  • 54 Raper DMS, Ding D, Chen C-J, Buell TJ, Crowley RW, Liu KC. Patency of the vein of Labbé after venous stenting of the transverse and sigmoid sinuses. J Neurointerv Surg 2017; 9 (06) 587-590
    CrossrefPubMedGoogle Scholar
  • 55 Satti SR, Leishangthem L, Spiotta A, Chaudry MI. Dural venous sinus stenting for medically and surgically refractory idiopathic intracranial hypertension. Interv Neuroradiol 2017; 23 (02) 186-193
    CrossrefPubMedGoogle Scholar
  • 56 Shazly TA, Jadhav AP, Aghaebrahim A. , et al. Venous sinus stenting shortens the duration of medical therapy for increased intracranial pressure secondary to venous sinus stenosis. J Neurointerv Surg 2018; 10 (03) 310-314
    CrossrefPubMedGoogle Scholar
  • 57 Shields LBE, Shields CB, Yao TL, Plato BM, Zhang YP, Dashti SR. Endovascular treatment for venous sinus stenosis in idiopathic intracranial hypertension: an observational study of clinical indications, surgical technique, and long-term outcomes. World Neurosurg 2019; 121: e165-e171
    CrossrefPubMedGoogle Scholar
  • 58 Smith KA, Peterson JC, Arnold PM, Camarata PJ, Whittaker TJ, Abraham MG. A case series of dural venous sinus stenting in idiopathic intracranial hypertension: association of outcomes with optical coherence tomography. Int J Neurosci 2017; 127 (02) 145-153
    CrossrefPubMedGoogle Scholar
  • 59 Spilberg GZ, Wajnberg E, Gasparetto EL, Magalhaes G. Case report: endovascular treatment of idiopathic intracranial hypertension. Pakistan J Radiol 2010; 20 (March): 23-26
    PubMedGoogle Scholar
  • 60 Teleb MS, Cziep ME, Issa M. , et al. Stenting and angioplasty for idiopathic intracranial hypertension: a case series with clinical, angiographic, ophthalmological, complication, and pressure reporting. J Neuroimaging 2015; 25 (01) 72-80
    CrossrefPubMedGoogle Scholar
  • 61 Xu Y, Meng R, Rajah GB. , et al. Long-term outcomes of cerebral venous sinus stenosis corrected by stenting. Curr Neurovasc Res 2019; 16 (01) 77-81
    CrossrefPubMedGoogle Scholar
  • 62 Young CC, Morton RP, Ghodke BV, Levitt MR. Retrograde 3D rotational venography (3DRV) for venous sinus stent placement in idiopathic intracranial hypertension. J Neurointerv Surg 2018; 10 (08) 777-779
    CrossrefPubMedGoogle Scholar
  • 63 Zheng H, Zhou M, Zhao B, Zhou D, He L. Pseudotumor cerebri syndrome and giant arachnoid granulation: treatment with venous sinus stenting. J Vasc Interv Radiol 2010; 21 (06) 927-929
    CrossrefPubMedGoogle Scholar
  • 64 Alessi G, Levrier O, Conrath J. , et al. [Optical coherence tomography in following up papilledema in idiopathic intracranial hypertension treated with lateral sinus stent placement]. J Fr Ophtalmol 2010; 33 (09) 637-648
    CrossrefPubMedGoogle Scholar
  • 65 Boddu S, Dinkin M, Suurna M, Hannsgen K, Bui X, Patsalides A. Resolution of pulsatile tinnitus after venous sinus stenting in patients with idiopathic intracranial hypertension. PLoS One 2016; 11 (10) e0164466
    CrossrefPubMedGoogle Scholar
  • 66 McDougall CM, Ban VS, Beecher J, Pride L, Welch BG. Fifty shades of gradients: does the pressure gradient in venous sinus stenting for idiopathic intracranial hypertension matter? A systematic review. J Neurosurg 2018; 130 (03) 999-1005
    CrossrefPubMedGoogle Scholar
  • 67 Raper DMS, Ding D, Buell TJ, Crowley RW, Starke RM, Liu KC. Effect of body mass index on venous sinus pressures in idiopathic intracranial hypertension patients before and after endovascular stenting. Neurosurgery 2018; 82 (04) 555-561
    CrossrefPubMedGoogle Scholar
  • 68 Lenck S, Vallée F, Civelli V. , et al. Assessment of blood flow velocities and venous pressures using a dual-sensor guidewire in symptomatic dural sinus stenoses. J Neurosurg 2018; 130 (06) 1-5
    Google Scholar
  • 69 Lavoie P, Audet M-È, Gariepy J-L. , et al. Severe cerebellar hemorrhage following transverse sinus stenting for idiopathic intracranial hypertension. Interv Neuroradiol 2018; 24 (01) 100-105
    CrossrefPubMedGoogle Scholar
  • 70 Buell TJ, Raper DM, Ding D, Chen C-J, Liu KC. Development of an intracranial dural arteriovenous fistula after venous sinus stenting for idiopathic intracranial hypertension. BMJ Case Rep 2017; 2017 DOI: 10.1136/bcr-2017-013282.
    CrossrefPubMedGoogle Scholar
  • 71 Coffman SA, Singh J, Wolfe S, Fargen KM. Unexpected occlusion of the contralateral transverse sinus after stenting for idiopathic intracranial hypertension. Interv Neuroradiol 2018; 24 (06) 718-721
    CrossrefPubMedGoogle Scholar
  • 72 West JL, Garner RM, Traunero JR, Wolfe SQ, Fargen KM. Changes in end-tidal carbon dioxide partial pressure alter venous sinus pressure measurements in idiopathic intracranial hypertension. World Neurosurg 2018; 120: 495-499
    CrossrefPubMedGoogle Scholar
  • 73 Buell TJ, Starke RM, Ding D. , et al. Venous sinus stenting using transcranial access for the treatment of idiopathic intracranial hypertension in a pediatric patient. J Neurosci Rural Pract 2017; 8 (04) 672-675
    Article in Thieme ConnectPubMedGoogle Scholar
  • 74 Yan F, Rajah G, Ding Y. , et al. Safety and efficacy of intravascular ultrasound as an adjunct to stenting for cerebral venous sinus stenosis-induced idiopathic intracranial hypertension: a pilot study. J Neurosurg 2019; DOI: 10.3171/2018.11.JNS181885. . [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 75 Raper DMS, Buell TJ, Ding D, Pomeraniec IJ, Crowley RW, Liu KC. A pilot study and novel angiographic classification for superior sagittal sinus stenting in patients with non-thrombotic intracranial venous occlusive disease. J Neurointerv Surg 2018; 10 (01) 74-77
    CrossrefPubMedGoogle Scholar
  • 76 Buell TJ, Raper DMS, Ding D. , et al. Concurrent venous stenting of the transverse and occipito-marginal sinuses: an analogy with parallel hemodynamic circuits. J Neurosci Rural Pract 2019; 10 (02) 334-338
    Article in Thieme ConnectPubMedGoogle Scholar
  • 77 Owler BK, Allan R, Parker G, Besser M. Pseudotumour cerebri, CSF rhinorrhoea and the role of venous sinus stenting in treatment. Br J Neurosurg 2003; 17 (01) 79-83
    CrossrefPubMedGoogle Scholar
  • 78 Iyer RR, Solomon D, Moghekar A. , et al. Venous sinus stenting in the management of patients with intracranial hypertension manifesting with skull base cerebrospinal fluid leaks. World Neurosurg 2017; 106: 103-112
    CrossrefPubMedGoogle Scholar
  • 79 Li K, Ren M, Meng R. , et al. Efficacy of stenting in patients with cerebral venous sinus thrombosis-related cerebral venous sinus stenosis. J Neurointerv Surg 2019; 11 (03) 307-312
    CrossrefPubMedGoogle Scholar