But a lack of good outcome data indicates there is more work to be done, with researchers calling for a randomized trial.
Transvenous dural venous stenting is associated with a lower rate of complications than surgical shunting and is effective at reducing sinus pressure, but the clinical outcomes still leave much to be desired, according to a retrospective review published online ahead of print last month in the Journal of Neurosurgery. The authors call for a randomized controlled trial to investigate the issue further.
There are currently no highly effective therapies for the management of idiopathic intracranial hypertension. Weight loss and use of intracranial pressure-lowering drugs often fail to resolve symptoms completely. Surgical options, including cerebral spinal fluid diversion (usually using a shunt) and optic nerve sheath fenestration, also lack high rates of efficacy, are also associated with a high risk of complications, and often require revision.
Recently, transvenous dural venous stenting has been investigated as a potential alternative therapy. “Although early clinical improvement following stent insertion has been described, sustained obliteration of anatomical stenosis, manometric gradient, control of [intracranial pressure (ICP)], and symptomatic improvement remain unproven,” write the authors, led by Hasan Asif, MRCS (National Hospital for Neurology and Neurosurgery, London, England). “Furthermore, the causal relationship between radiographic anatomical stenosis and raised ICP remains unclear.”
To better understand the clinical efficacy and safety of transvenous dural venous stenting for the treatment of idiopathic intracranial hypertension, Asif and colleagues reviewed clinical, radiographic, and manometric data collected before and 3 to 4 months after stenting among 41 patients with the condition. All venographic and manometric procedures were performed under local anesthesia with the patient supine.
Good Clinical Outcomes Still Lacking
Stenting resulted in reductions of sinus pressure of between 11 and 15 mm Hg from baseline, when measured 3 to 4 months after the procedure, no matter whether the intervention was primary or secondary to shunt surgery. Radiographic obliteration of anatomical stenosis correlated with a decrease in pressure gradients.
At 120 days following stenting, the complication rate was 4.9% and 87.8% of patients had not required reintervention. At least 20% of patients developed restenosis, and only 63.3% demonstrated an improvement or resolution of papilledema.
Stenting “showed lower complication rates than shunts, but the clinical outcome data were less convincing,” conclude the authors, noting that “a randomized prospective study is needed.”
Source:
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. 2017;Epub ahead of print.
Disclosures:
Asif reports no relevant conflicts of interest.
