Venous sinus stenting for pseudotumor cerebri
Date First Published:
May 3, 2006
Last Updated:
May 4, 2006
Report by:
Faiez Al Nimer, Senior House Officer, neurology clinic (Karolinska Hospital)
Three-Part Question:
In [patients with pseudotumor cerebri] does [venous sinus stenting] improve [headache and papilledema]
Clinical Scenario:
A patient presents with headache and transient visual loss. He is diagnosed with pseudotumor cerebri. Conservative therapy fails. Could sinus stenting be an alternative treatment?
Search Strategy:
Medline 1966-05/2006 using the PubMed interface
Search Details:
(pseudotumor cerebri) OR (benign intracranial hypertension) AND (sinus stenting)
Outcome:
7 papers found of which 2 were irrelevant to the study question or of insufficient quality for inclusion
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Venous sinus stenting for refractory benign intracranial hypertension. Higgins JN, Owler BK, Cousins C, Pickard JD. 19-Jan-02 UK | 1 patient with pseudotumor cerebri, headache and papilledema. 3 weeks and 1 year follow up |
Case Report | Headache | Improvement | Only 1 patient |
| Visual Disturbance | Cure | ||||
| Pseudotumour cerebri, CSF rhinorrhoea and the role of venous sinus stenting in treatment. Owler BK, Allan R, Parker G, Besser M. Feb-03 Australia | 1 patient with pseudotumor cerebri for 10 years who developed CSF rhinorrhoea. Direct retrograde cerebral venography (DRCV) demonstrated venous sinus obstruction due to a filling defect. | Case study | Venous sinus obstruction | Treated | Symptom treatment? 1 patient. |
| Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. Higgins JN, Cousins C, Owler BK, Sarkies N, Pickard JD. Dec-03 UK | 12 patients with refractory IIH had dilatation of venous sinus. Intrasinus pressures were recorded before and after the procedure. Patients were assessed at 8–12 weeks |
Case review | Headache | 5 treated, 2 improved, 5 untreated | Only 12 patients |
| Papilledema | 4/8 improved | ||||
| Endovascular stenting of the transverse sinus in a patient presenting with benign intracranial hypertension. Ogungbo B, Roy D, Gholkar A, Mendelow AD. Dec-03 UK | 37-year-old lady with symptoms and signs suggestive of benign intracranial hypertension. Obstruction of the right transverse sinus with high pressure (40 mmHg) proximal to the obstruction and low pressure (15 mmHg) distally. 3- and 6-month follow up |
Case report | Headache | Cured | 1 patient |
| Visual disturbance/papilledema | Cured | ||||
| Transverse venous sinus stent placement as treatment for benign intracranial hypertension in a young male: case report and review of the literature. Rajpal S, Niemann DB, Turk AS. Apr-05 USA | 15-year-old boy with pseudotumor cerebri. 1-, 2- and 6-months follow up |
Case Report | Headache | treated | 1 patient |
| Papilledema | treated |
Author Commentary:
There are only 4 case reports and 1 review with 12 patients in the literature. No RTCs. No long term follow ups.
Bottom Line:
Venous sinus stenting may prove to be a beneficial and minimally invasive treatment option for these individuals. However more studies and RCTs are required to prove that, to address the complications and to characterize the patient subgroups that would benefit from venous sinus stenting.
References:
- Higgins JN, Owler BK, Cousins C, Pickard JD.. Venous sinus stenting for refractory benign intracranial hypertension.
- Owler BK, Allan R, Parker G, Besser M.. Pseudotumour cerebri, CSF rhinorrhoea and the role of venous sinus stenting in treatment.
- Higgins JN, Cousins C, Owler BK, Sarkies N, Pickard JD.. Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting.
- Ogungbo B, Roy D, Gholkar A, Mendelow AD.. Endovascular stenting of the transverse sinus in a patient presenting with benign intracranial hypertension.
- 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.