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Long-term Kinetic Papilledema Improvement After Venous Sinus Stenting in Idiopathic Intracranial Hypertension

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Abstract

Background and Purpose

The aim of this study was to assess the safety and effectiveness of lateral sinus stenosis (LSS) stenting in patients with idiopathic intracranial hypertension (IIH) who are refractory to medical treatment, particularly focusing on visual outcomes including papilledema.

Material and Methods

Retrospective study of consecutive patients with IIH refractory to medical treatment who underwent LSS stenting. Clinical features, visual fields and optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thicknesses were assessed before stenting, at 1 month poststenting and at last follow-up. Complications were also recorded.

Results

A total of 16 women were included, with a mean age of 39 ± 11 years. All patients had papilledema while 15/16 (94%) had headaches. Mean visual acuity was 0.036 logMAR, range (+0.4 to +0.0 logMAR). The mean RNFL thickness prior to stenting was 121.7 µm (±34.7 µm) and mean GCL thickness was 80.2 µm (±8.9 µm). Mean follow-up was 19.7 months (±11.8 months). After stenting, acetazolamide was discontinued in 15/16 (94%) patients. Papilledema improved in 14/16 (88%) of patients. The mean RNFL thickness was significantly decreased 1 month after stenting (96.3 ± 15.6 µm; p < 0.001) and at last visit (93.4 ± 15.3 µm; p < 0.001). The GCL thickness after LSS stenting was moderately decreased at the last visit examination: 80.2 ± 8.9 µm vs. 78.0 ± 10.7 µm; (p < 0.01). No stent-related complication occurred, while there was one case of restenosis.

Conclusion

Improvement of papilledema appears to occur relatively rapidly after the LSS stenting. The results further support the role of LSS stenting in the treatment of IIH, especially with respect to visual symptoms.

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Authors and Affiliations

  1. Department of Ophthalmology, Pitié-Salpêtrière Hospital, APHP, 47, Bd de l’Hôpital, 75013, Paris, France

    Romain Touzé, Sophie Bonnin, Bahram Bodaghi & Valérie Touitou

  2. Department of Ophthalmology, Lariboisière Hospital, APHP, Paris, France

    Sophie Bonnin

  3. Department of Neuroradiology, Lariboisière Hospital, APHP, Paris, France

    Emmanuel Houdart

  4. Joint Division of Medical Imaging, Department of Medical Imaging, UHN, University of Toronto, Toronto, Ontario, Canada

    Patrick Nicholson

  5. Paris VI University, Sorbonne University, Paris, France

    Bahram Bodaghi, Frédéric Clarençon & Valérie Touitou

  6. Department of Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France

    Eimad Shotar, Frédéric Clarençon & Stéphanie Lenck

Authors
  1. Romain Touzé
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  2. Sophie Bonnin
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  3. Emmanuel Houdart
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  4. Patrick Nicholson
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  8. Stéphanie Lenck
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  9. Valérie Touitou
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Contributions

All authors read and approved the submitted manuscript; the manuscript has not been submitted elsewhere nor published elsewhere in whole or in part. All authors contributed to the study conception and design. Data collection was performed by Romain Touzé, Sophie Bonnin and Stéphanie Lenck. Data analysis was performed by Romain Touzé and Sophie Bonnin. The first draft of the manuscript was written by Romain Touzé, Sophie Bonnin and Stéphanie Lenck, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Romain Touzé.

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Conflict of interest

R. Touzé, S. Bonnin, E. Houdart, P. Nicholson, B. Bodaghi, E. Shotar, S. Lenck, V. Touitou declare that they have no competing interests. F. Clarençon: Unrelated: Medtronic, Guerbet, Balt Extrusion (payment for readings), and Codman Neurovascular (core laboratory).

Ethical standards

This study has been approved by the local ethics committee (IRB 00008855). Because this study used data obtained as part of standard of care, the requirement for informed consent was waived.

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The authors declare that all data concerning this study are available on request.

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Touzé, R., Bonnin, S., Houdart, E. et al. Long-term Kinetic Papilledema Improvement After Venous Sinus Stenting in Idiopathic Intracranial Hypertension. Clin Neuroradiol 31, 483–490 (2021). https://doi.org/10.1007/s00062-020-00908-z

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  • DOI: https://doi.org/10.1007/s00062-020-00908-z

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