Stenting Offers Fewer Complications for Idiopathic Intracranial Hypertension

Venous sinus stenting is a safe, effective treatment for idiopathic intracranial hypertension and is associated with significant improvements in papilledema and headaches, according to research presented at the North American Neuro-Ophthalmology Society (NANOS) 2021 Annual Meeting. The meeting was held virtually from February 20 to February 23, 2021. 

Researchers from the New England Eye Center at Tufts Medical Center in Boston, Massachusetts, evaluated changes to renal nerve fibers after venous sinus stenting to treat idiopathic intracranial hypertension. This treatment methodology has demonstrated significant improvement in papilledema, visual fields, and headaches, and has been associated with lower rates of complications and failures compared with shunting. 

The study included 17 eyes from 9 patients with idiopathic intracranial hypertension. Researchers measured the patients’ visual fields and used optical coherence tomography (OCT) to measure both the retinal nerve fiber layer (RNFL) and the ganglion cell layer inner plexiform layer (GCL-IPL). 

Investigators found a “noticeable decrease” in RNFL thickness between 2 and 4 weeks after stenting. Between 90 and 100 days after stenting, papilledema had resolved in nearly all patients. Ganglion cell layer IPL remained stable throughout the follow-up period and corresponded accurately with final visual outcomes. In 3 patients, the GCL-IPL algorithm failed preoperatively; these patients had retinal nerve fiber layer measurements thicker than 300 µm. In patients with measurements closer to 200 µm, GCL IPL measurements were more accurate. 

Investigators also shared the specific case of 1 patient (Patient 6), a 32-year-old woman who was overweight and had gained 40 lbs secondary to systemic lupus erythematosus nephritis and required chronic steroids. The patient presented with 5 months of headaches and 5 weeks of binocular horizontal diplopia, bilateral papilledema, and visual field loss, as well as preserved visual acuity and color vision. 

Magnetic resonance imaging and magnetic resonance venography both indicated venous sinus stenosis. Due to her nephritis and difficulties with weight loss, the investigators determined that acetazolamide dosing would be difficult; following evaluation, they determined that the patient was a candidate for stenting. 

Two weeks following stenting, the patient’s RNFL measurements improved by more than 50% bilaterally, and her GCL-IPL measurements were normal. At 3-months postoperative, papilledema also resolved, and optic nerves were “pink with sharp margins.” The patient’s examinations and OCT readings were stable and normal at postoperative year 2. Although visual field testing at postoperative month 3 demonstrated defects, the researchers noted that “testing parameters were unreliable and did not correspond with her OCT.”

“Venous sinus stenting is an effective treatment for [idiopathic intracranial hypertension] with rapid decrease in papilledema 2 [to] 4 weeks after surgery with good visual outcome,” the research says. “More and longer-term data continue to be collected to further understand the benefits of [venous sinus stenting] over time.” 

Reference

Vuong LN, Malek AM, Paez YM, Hedges III TR. Resolution of papilledema after venous sinus stenting for IIH. Presented at: North American Neuro-Ophthalmology Society (NANOS) 2021 Annual Meeting; February 20-23, 2021; Poster 220.