- Oral presentation
- Open Access
Endovascular treatment considerations in Idiopathic Intracranial Hypertension (IIH)
© Pulhorn et al. 2015
- Published: 18 September 2015
- Endovascular Treatment
- Venous Sinus
- Idiopathic Intracranial Hypertension
- Venous Hypertension
- Final Common Pathway
Impaired cerebral venous sinus outflow leading to cerebral venous hypertension has been implicated as a potential final common pathway in the pathophysiology of idiopathic intracranial hypertension (IIH). The aim of this study is to assess the role of endovascular management strategies in the form of either primary venous sinus angioplasty or venous stenting for refractory IIH.
Retrospective study of 37 consecutive patients with refractory IIH and imaging evidence of cerebral venous sinus outflow impairment. Primary venous angioplasty or secondary stenting were performed and clinical outcomes were documented on a standardised proforma.
20 out of the 37 cases showed positive pressure gradients and had endovascular management where there was variable reduction of the pressure gradient. 17 (of whom 12 had only sinus venoplasty and 5 had venoplasty followed by sinus stenting) out of 20 showed clinical improvement or resolution of symptoms. 3 patients were refractory to endovascular management and stabilised after ventriculo-peritoneal shunting.
The pathophysiology of IIH from venous hypertension secondary to venous outflow impairment is controversial. A selected group of patients with IIH and cerebral venous outflow impairment can benefit from endovascular treatment. In our experience 60% of patients showed clinical improvement with primary sinus venous angioplasty alone. This is a potential alternative to CSF shunting or primary stenting of venous sinus. After additional venous sinus stenting of refractory cases 85% of our patients in our cohort improved clinically.
- Pülhorn H, Kareem H, Ulbricht C: Intradural migration of cervical posterior fixation rods. Eur Spine J. 2015 Jun 5, [Epub ahead of print]Google Scholar
- Pülhorn H, Pesic-Smith J, Cowley P, Murphy M: Cerebral Aneurysms and Accelerated Atherosclerosis in Russell-Silver Syndrome. A New Subtype?. J Neurosurg. 2015 Jan 2, 1-3. [Epub ahead of print]Google Scholar
- Pülhorn H, Bradford R, Dorward N, Murphy M, Shieff C, Thorne L, Maurice-Williams R: The history of Neurosurgery at The Royal Free Hospital. Br J Neurosurg. 2014, 28 (3): 387-9. 10.3109/02688697.2014.915009. doi: 10.3109/02688697.2014.915009. Epub 2014 May 8View ArticlePubMedGoogle Scholar
- Pülhorn H, Hartley J C, Shanmuganathan M, Lee C H, Harkness W, Thompson DNP: Central nervous system infection after Onyx embolization of arterio-venous malformations in two paediatric patients. Childs Nervous System. 2014, DOI 10.1007/s00381-014-2447-yGoogle Scholar
- Pülhorn H, Herrmann M, Harms H, Jung A, Baumann I: Apoptotic cells and clonally expanded cytotoxic T cells in bone marrow trephines of patients with myelodysplastic syndrome. Histopathology. 2012, 61: 200-211. 10.1111/j.1365-2559.2012.04209.x.View ArticlePubMedGoogle Scholar
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