Clinical Research Of Percutaneous Venous Sinus Stenting In The Treatment Of Idiopathic Intracranial Hypertension Associated With Venous Sinus Stenosis

Object:So far,many studies have shown that increased venous sinus pressure caused by cerebral venous sinus stenosis（CVSS）is associated with idiopathic intracranial hypertension（IIH）.At present,percutaneous venous sinus stenting is an alternative treatment for patients with IIH who have failed to respond to routine medical treatment.This research will further explore the feasibility of percutaneous venous sinus stenting for treatment of IIH combined with CVSS.Methods:This research was a single-center retrospective study.We continuously included patients with IIH and CVSS treated by percutaneous venous sinus stenting in the cerebrovascular disease center of the department of neurology,the first hospital of Jilin university.All patients underwent preoperative retrograde venous sinus angiography,pressure measurement and other examinations,which confirmed that there was a significant pressure difference on both sides of venous sinus stenosis.Stenting was planned for all patients and the indicators of clinical symptom improvement,technical success rate and perioperative complications were observed.Long-term results were followed up regularly after the operation to observe the degree of improvement of symptoms and the recurrence or deterioration of symptoms.The relevant data was represented by the mean or median.Results:A total of 11 patients were recruited into the research from January 2017to August 2019,including 8 females and 3 males.Ages ranged from 26 to51 with a median age of 35.BMI ranged from 24.02 to 32.81Kg/m2with a median of 26.67 Kg/m2.The onset time ranged from 10 days to 2 years,with a median of 1.5 months.Preoperative lumbar puncture pressure was290-430mmH₂O with a median of 400mmH₂O,which greater than250mmH2O（1mmH₂O=0.0098kPa）.Venous sinus radiography revealed one patient with dominant right transverse-sigmoid sinus junction stenosis,one patient with balanced bilateral sinus but the right transverse-sigmoid sinus junction was narrow,one patient had dominant left transverse-sigmoid sinus junction stenosis,one patient had localized stenosis of the dominant right transverse sinus.The remaining seven patients had bilateral transverse-sigmoid sinus junction stenosis,including four cases with bilateral balanced development but two cases on the left side of the differential pressure slightly increased,one case on the right side slightly increases,one case was same on both sides.In addition,the left side was dominant in three cases,the pressure difference on the right side was large in two cases,and the pressure difference on both sides was the same in one case.Venous sinus pressure showed the pressure difference was between13 and 31.7mmHg with a median of 16.7 mmHg.All eight patients were successfully treated with unilateral venous sinus stents under general anesthesia,two patients were treated with bilateral stents,and one patient was not successfully implanted with stents due to intraoperative complications.The median reduction of bilateral pressure difference was16.4mmHg（14.2-27.55）in 5 stenosis sites after stent implantation（except other seven cases due to the pressure difference was not measured after surgery）.The median reduction of lumbar puncture pressure was 120mmH₂O（50-170）in nine patients（except other two patients because one patient did not receive stent implantation due to intraoperative complications,and one patient had increased intracranial pressure due to postoperative complications）.Extensive venous thrombosis occurred in one patient,cerebral hemorrhage occurred in one patient,and artery fistula and arteriovenous fistula occurred in one patient.About follow-up,one patient has slightly worse vision,one patient with headache but does not affect the life and work and clinical symptoms in other patients almost completely disappeared or disappeared completely.jugular vein ultrasound examination showed internal jugular vein reflux unobstructed.Optic nerve sheath to evaluate high cranial pressure tests showed papillary edema of the optic nerve was significantly improved or disappeared.The optic nerve sheath width obviously improved or return to normal（two patients with complications were not regularly follow-up after discharge,but telephone follow-up revealed that the symptoms improved significantly after further treatment in the other hospital）.Conclusions:（1）Stenting of venous sinus can significantly improve the symptoms of IIH combined with CVSS,which is not ideal for medical treatment.（2）Venous sinus stenting surgery is risky and should be carried out with caution.（3）The stenting of venous sinus may be one of the IIH treatment options,but the safety and efficacy of surgery still need to be evaluated in more larger study.