Idiopathic Intracranial Hypertension (IIH) which is also called Pseudotumor cerebri is an uncommon condition, associated with increases intracranial pressure. It mostly affects young obese females. The most common symptoms include headache, visual disturbance and tinnitus (ringing sound in the ear). In about one third of cases, IIH is caused by stenosis (obstruction) of outflow from dural venous sinus. [1] In some studies, stenosis of dural venous sinus has been demonstrated in up to 93% of patients with IIH. [1, 2, & 3]
The treatment of IIH includes medical management and surgical treatment. Medical treatment consists of medications to reduce intracranial pressure by decreasing production of cerebrospinal fluid (CSF) and symptomatic treatment of headache. Surgical treatment of IIH include diversion of CSF by ventriculoperitoneal or lumboperitoneal shunt (VPS or LPS).
Given the fact that the stenosis of dural venous sinus is a causative factor in many cases of IIH, endovascular stenting of dural venous sinus is a therapeutic option for cases of IIH which are resistant to medical treatment. Prior to stent placement in venous sinus, your endovascular surgeon will do a diagnostic angiography and venous pressure measurement. The surgeon will make a small incision in your groin and pass navigating catheters through femoral artery, up in to blood vessels and sinus in your brain. If your surgeon notices significant stenosis of venous sinus, he or she may place a stent in the narrowed part of venous sinus to restore its outflow and to relive the high intracranial pressure. Before the stent placement, you will be pre-treated with aspirin and clopidogrel which will be continued for 6 months after the procedure. Beyond 6 months of dual antiplatelet therapy, you will on aspirin indefinitely.
Please see section of neurosurgical procedures for more information on surgical treatment by shunt placement.
References
- Johnston I, Kollar C, Dunkley S, Assaad N, Parker G. Cranial venous outflow obstruction in the pseudotumour syndrome: incidence, nature and relevance. J Clin Neurosci. 2002 May;9(3):273-8.
- Farb RI, Vanek I, Scott JN, Mikulis DJ, Willinsky RA, Tomlinson G, et al.: Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 60:1418–1424, 2003
- Higgins JN, Gillard JH, Owler BK, Harkness K, Pickard JD: MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood. J Neurol Neurosurg Psychiatry 75:621–625, 2004