Venous Stenting for Idiopathic Intracranial Hypertension

  • Marc Dinkin
  • Anat Kesler


Idiopathic intracranial hypertension is a syndrome affecting mostly obese women of childbearing age leading to symptoms and signs of elevated intracranial pressure including papilledema. Management includes weight loss and medications that reduce intracranial pressure, but when these conservative therapies fail, surgical intervention may be warranted to prevent potentially irreversible vision loss. Based upon an observed association between stenosis at the junction of the transverse and sigmoid venous sinuses, endovascular stenting of the stenotic region has emerged as a potential therapeutic option, alongside more established surgical interventions such as CSF shunt procedures and optic nerve sheath fenestration. In this chapter, we review the theoretical basis explaining the relationship between venous stenosis and idiopathic intracranial hypertension, and summarize the outcomes associated with this innovative treatment to date.


Venous sinus stenting Idiopathic intracranial hypertension 


  1. 1.
    Quincke H. Meningitis serosa. Samml Klin Vortr Leipz 189367 Inn Med 23655; 1893.Google Scholar
  2. 2.
    Dandy WE. Intracranial pressure without brain tumor: diagnosis and treatment. Ann Surg. 1937;106(4):492–513.CrossRefGoogle Scholar
  3. 3.
    NORDIC Idiopathic Intracranial Hypertension Study Group Writing Committee, Wall M, McDermott MP, et al. Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA. 2014;311(16):1641–51. Scholar
  4. 4.
    Wall M, George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain J Neurol. 1991;114(Pt 1A):155–80.Google Scholar
  5. 5.
    Thambisetty M, Lavin PJ, Newman NJ, Biousse V. Fulminant idiopathic intracranial hypertension. Neurology. 2007;68(3):229–32.CrossRefGoogle Scholar
  6. 6.
    Satti SR, Leishangthem L, Chaudry MI. Meta-analysis of CSF diversion procedures and dural venous sinus stenting in the setting of medically refractory idiopathic intracranial hypertension. AJNR Am J Neuroradiol. 2015;36(10):1899–904. Scholar
  7. 7.
    King JO, Mitchell PJ, Thomson KR, Tress BM. Cerebral venography and manometry in idiopathic intracranial hypertension. Neurology. 1995;45(12):2224–8.CrossRefGoogle Scholar
  8. 8.
    Farb RI, Vanek I, Scott JN, Mikulis DJ, Willinsky RA, Tomlinson G, terBrugge KG. Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology. 2003;60(9):1418–24.CrossRefGoogle Scholar
  9. 9.
    Aslan K, Gunbey HP, Tomak L, Ozmen Z, Incesu L. Magnetic resonance imaging of intracranial hypotension: diagnostic value of combined qualitative signs and quantitative metrics. J Comput Assist Tomogr. 2018;42(1):92–9.PubMedGoogle Scholar
  10. 10.
    King JO, Mitchell PJ, Thomson KR, Tress BM. Manometry combined with cervical puncture in idiopathic intracranial hypertension. Neurology. 2002;58(1):26–30.CrossRefGoogle Scholar
  11. 11.
    Rohr A, Dörner L, Stingele R, Buhl R, Alfke K, Jansen O. Reversibility of venous sinus obstruction in idiopathic intracranial hypertension. AJNR Am J Neuroradiol. 2007;28(4):656–9.PubMedGoogle Scholar
  12. 12.
    Buell TJ, Raper DMS, Pomeraniec IJ, Ding D, Chen CJ, Taylor DG, Liu KC. Transient resolution of venous sinus stenosis after high-volume lumbar puncture in a patient with idiopathic intracranial hypertension. J Neurosurg. 2018;129(1):153–6. Scholar
  13. 13.
    Bono F, Giliberto C, Mastrandrea C, Cristiano D, Lavano A, Fera F, Quattrone A. Transverse sinus stenoses persist after normalization of the CSF pressure in IIH. Neurology. 2005;65(7):1090–3.CrossRefGoogle Scholar
  14. 14.
    De Simone R, Ranieri A, Montella S, Bilo L, Cautiero F. The role of dural sinus stenosis in idiopathic intracranial hypertension pathogenesis: the self-limiting venous collapse feedback-loop model. Panminerva Med. 2014;56(3):201–9.PubMedGoogle Scholar
  15. 15.
    Stevens SA, Stimpson J, Lakin WD, Thakore NJ, Penar PL. A model for idiopathic intracranial hypertension and associated pathological ICP wave-forms. IEEE Trans Biomed Eng. 2008;55(2 Pt 1):388–98. Scholar
  16. 16.
    De Simone R, Marano E, Fiorillo C, Briganti F, Di Salle F, Volpe A, Bonavita V. Sudden re-opening of collapsed transverse sinuses and longstanding clinical remission after a single lumbar puncture in a case of idiopathic intracranial hypertension. Pathogenetic implications. Neurol Sci. 2005;25(6):342–4.CrossRefGoogle Scholar
  17. 17.
    Lazzaro MA, Darkhabani Z, Remler BF, Hong SH, Wolfe TJ, Zaidat OO, Fitzsimmons BF. Venous sinus pulsatility and the potential role of dural incompetence in idiopathic intracranial hypertension. Neurosurgery. 2012;71(4):877–83.CrossRefGoogle Scholar
  18. 18.
    Lublinsky S, Friedman A, Kesler A, Zur D, Anconina R, Shelef I. Automated cross-sectional measurement method of intracranial dural venous sinuses. AJNR Am J Neuroradiol. 2016;37(3):468–74.CrossRefGoogle Scholar
  19. 19.
    Anconina R, Zur D, Kesler A, Lublinsky S, Toledano R, Novack V, Benkobich E, Novoa R, Novic EF, Shelef I. Creating normograms of dural sinuses in healthy persons using computer-assisted detection for analysis and comparison of cross-section dural sinuses in the brain. J Clin Neurosci. 2017;40:190–4.CrossRefGoogle Scholar
  20. 20.
    Zur D, Anconina R, Kesler A, Lublinsky S, Toledano R, Shelef I. Quantitative imaging biomarkers for dural sinus patterns in idiopathic intracranial hypertension. Brain Behav. 2017;7(2):e00613.CrossRefGoogle Scholar
  21. 21.
    Rohr A, Bindeballe J, Riedel C, van Baalen A, Bartsch T, Doerner L, Jansen O. The entire dural sinus tree is compressed in patients with idiopathic intracranial hypertension: a longitudinal, volumetric magnetic resonance imaging study. Neuroradiology. 2012;54(1):25–33. Scholar
  22. 22.
    Raper DMS, Ding D, Buell TJ, Crowley RW, Starke RM, Liu KC. Effect of body mass index on venous sinus pressures in idiopathic intracranial hypertension patients before and after endovascular stenting. Neurosurgery. 2018;82(4):555–61. Scholar
  23. 23.
    Higgins JN, Cousins C, Owler BK, Sarkies N, Pickard JD. Idiopathic intracranial hypertension: 12 cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry. 2003;74(12):1662–6. Review.CrossRefGoogle Scholar
  24. 24.
    Ahmed RM, Wilkinson M, Parker GD, Thurtell MJ, Macdonald J, McCluskey PJ, Allan R, Dunne V, Hanlon M, Owler BK, Halmagyi GM. Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. AJNR Am J Neuroradiol. 2011;32(8):1408–14. Scholar
  25. 25.
    Donnet A, Metellus P, Levrier O, Mekkaoui C, Fuentes S, Dufour H, Conrath J, Grisoli F. Endovascular treatment of idiopathic intracranial hypertension: clinical and radiologic outcome of 10 consecutive patients. Neurology. 2008;70(8):641–7. Scholar
  26. 26.
    He CZ, Ji XM, Wang LJ, Liu XT, Zhang X, Wang S, Chen J, Ling F. [Endovascular treatment for venous sinus stenosis in idiopathic intracranial hypertension]. Zhonghua Yi Xue Za Zhi. 2012;92(11):748–51. [Article in Chinese].Google Scholar
  27. 27.
    Dinkin MJ, Patsalides A. Venous sinus stenting in idiopathic intracranial hypertension: results of a prospective trial. J Neuroophthalmol. 2017;37(2):113–21. Scholar
  28. 28.
    Elder BD, Goodwin CR, Kosztowski TA, Radvany MG, Gailloud P, Moghekar A, Subramanian PS, Miller NR, Rigamonti D. Venous sinus stenting is a valuable treatment for fulminant idiopathic intracranial hypertension. J Clin Neurosci. 2015;22(4):685–9. Scholar
  29. 29.
    Smith KA, Peterson JC, Arnold PM, Camarata PJ, Whittaker TJ, Abraham MG. A case series of dural venous sinus stenting in idiopathic intracranial hypertension: association of outcomes with optical coherence tomography. Int J Neurosci. 2017;127(2):145–53.CrossRefGoogle Scholar
  30. 30.
    Liu KC, Starke RM, Durst CR, Wang TR, Ding D, Crowley RW, Newman SA. Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study. J Neurosurg. 2016;127:1–8. Scholar
  31. 31.
    Matloob SA, Toma AK, Thompson SD, Gan CL, Robertson F, Thorne L, Watkins LD. Effect of venous stenting on intracranial pressure in idiopathic intracranial hypertension. Acta Neurochir. 2017;159(8):1429–37. Scholar
  32. 32.
    Fargen KM, Velat GJ, Lewis SB, Hoh BL, Mocco J, Lawson MF. Concomitant intracranial pressure monitoring during venous sinus stenting for intracranial hypertension secondary to venous sinus stenosis. J Neurointerv Surg. 2013;5(4):e22. Scholar
  33. 33.
    Boddu S, Dinkin M, Suurna M, Hannsgen K, Bui X, Patsalides A. Resolution of pulsatile tinnitus after venous sinus stenting in patients with idiopathic intracranial hypertension. PLoS One. 2016;11(10):e0164466. eCollection 2016.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Albuquerque FC, Dashti SR, Hu YC, Newman CB, Teleb M, McDougall CG, et al. Intracranial venous sinus stenting for benign intracranial hypertension: clinical indications, technique, and preliminary results. World Neurosurg. 2011;75(5–6):648–52; discussion 592–5. Scholar
  35. 35.
    Ducruet AF, Crowley RW, McDougall CG, Albuquerque FC. Long-term patency of venous sinus stents for idiopathic intracranial hypertension. J Neurointerv Surg. 2014;6(3):238–42. Scholar
  36. 36.
    Alessi G, Levrier O, Conrath J, Hoffart L, Donnet A, L’attention L, Metellus P, Giorgi R, Matonti F, Ridings B. [Optical coherence tomography in following up papilledema in idiopathic intracranial hypertension treated with lateral sinus stent placement]. J Fr Ophtalmol. 2010;33(9):637–648. Scholar
  37. 37.
    Shazly TA, Jadhav AP, Aghaebrahim A, Ducruet AF, Jankowitz BT, Jovin TG, Bonhomme GR. Venous sinus stenting shortens the duration of medical therapy for increased intracranial pressure secondary to venous sinus stenosis. J Neurointerv Surg. 2018;10(3):310–4. Scholar
  38. 38.
    Bussière M, Falero R, Nicolle D, Proulx A, Patel V, Pelz D. Unilateral transverse sinus stenting of patients with idiopathic intracranial hypertension. AJNR Am J Neuroradiol. 2010;31(4):645–50. Scholar
  39. 39.
    Fields JD, Javedani PP, Falardeau J, Nesbit GM, Dogan A, Helseth EK, Liu KC, Barnwell SL, Petersen BD. Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension. J Neurointerv Surg. 2013;5(1):62–8. Scholar
  40. 40.
    Radvany MG, Solomon D, Nijjar S, Subramanian PS, Miller NR, Rigamonti D, Blitz A, Gailloud P, Moghekar A. Visual and neurological outcomes following endovascular stenting for pseudotumor cerebri associated with transverse sinus stenosis. J Neuroophthalmol. 2013;33(2):117–22. Scholar
  41. 41.
    Satti SR, Leishangthem L, Spiotta A, Chaudry MI. Dural venous sinus stenting for medically and surgically refractory idiopathic intracranial hypertension. Interv Neuroradiol. 2017;23(2):186–93. Scholar
  42. 42.
    Kumpe DA, Bennett JL, Seinfeld J, Pelak VS, Chawla A, Tierney M. Dural sinus stent placement for idiopathic intracranial hypertension. J Neurosurg. 2012;116(3):538–48.CrossRefGoogle Scholar
  43. 43.
    Ahmed R, Friedman DI, Halmagyi GM. Stenting of the transverse sinuses in idiopathic intracranial hypertension. J Neuroophthalmol. 2011;31(4):374–80. Scholar
  44. 44.
    Levitt MR, Albuquerque FC, Ducruet AF, Kalani MY, Mulholland CB, McDougall CG. Venous sinus stenting for idiopathic intracranial hypertension is not associated with cortical venous occlusion. J Neurointerv Surg. 2016;8(6):594–5. Scholar
  45. 45.
    Raper DMS, Ding D, Chen CJ, Buell TJ, Crowley RW, Liu KC. Patency of the vein of Labbé after venous stenting of the transverse and sigmoid sinuses. J Neurointerv Surg. 2017;9(6):587–90. Scholar
  46. 46.
    Lavoie P, Audet MÈ, Gariepy JL, Savard M, Verreault S, Gourdeau A, Milot G, Carrondo Cottin S. Severe cerebellar hemorrhage following transverse sinus stenting for idiopathic intracranial hypertension. Interv Neuroradiol. 2018;24(1):100–5. Scholar
  47. 47.
    Aguilar-Pérez M, Martinez-Moreno R, Kurre W, Wendl C, Bäzner H, Ganslandt O, Unsöld R, Henkes H. Endovascular treatment of idiopathic intracranial hypertension: retrospective analysis of immediate and long-term results in 51 patients. Neuroradiology. 2017;59(3):277–87.CrossRefGoogle Scholar
  48. 48.
    Raper D, Buell TJ, Ding D, Chen CJ, Starke RM, Liu KC. Pattern of pressure gradient alterations after venous sinus stenting for idiopathic intracranial hypertension predicts stent-adjacent stenosis: a proposed classification system. J Neurointerv Surg. 2018;10(4):391–5. Scholar
  49. 49.
    Kumpe DA, Seinfeld J, Huang X, Mei Q, Case DE, Roark CD, Subramanian PS, Lind KE, Pelak VS, Bennett JL. Dural sinus stenting for idiopathic intracranial hypertension: factors associated with hemodynamic failure and management with extended stenting. J Neurointerv Surg. 2017;9(9):867–74. Scholar
  50. 50.
    Goodwin CR, Elder BD, Ward A, Orkoulas-Razis D, Kosztowski TA, Hoffberger J, Moghekar A, Radvany M, Rigamonti D. Risk factors for failed transverse sinus stenting in pseudotumor cerebri patients. Clin Neurol Neurosurg. 2014;127:75–8. Scholar
  51. 51.
    Levitt MR, Albuquerque FC, Gross B, Moon K, Jadhav AP, Ducruet AF, Crowley RW. Venous sinus stenting in patients without idiopathic intracranial hypertension. J Neurointerv Surg. 2017;9(5):512–5. Scholar
  52. 52.
    Chandran A, Pulhorn H, McMahon C. Idiopathic intracranial hypertension VISION (venous intervention versus shunting in IIH for optic nerve disc swelling) trial: patient perspective questionnaire. Br J Neurosurg 2017; 21:1–5.

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyWeill Cornell Medical College, New York Presbyterian HospitalNew YorkUSA
  2. 2.Department of NeurologyWeill Cornell Medical College, New York Presbyterian HospitalNew YorkUSA
  3. 3.Department of Ophthalmology, Hillel Yaffe Medical CenterHaderaIsrael
  4. 4.Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael

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