Stenting treatment for lateral sinus stenosis with isolated intracranial hypertension / 中华神经科杂志

ABSTRACT

Objective To investigate the clinical,therapeutic and prognostic features of patients with lateral sinus stenosis and isolated intracranial hypertension,and further explore the possible mechanisms of their coexistence.Methods We retrospectively enrolled 16 patients with neurosurgery in our hospital from January 2009 to December 2016,who were clinically diagnosed as simple intracranial hypertension with bilateral or predominant lateral sinus stenosis and lateral stenting.These 16 patients were recorded surgical procedures and postoperative outcomes,and followed-up to understand the long-term prognosis of them.Results There were 14 females in the 16 patients,with an average age of (32.4 ± 10.1) years,a mean duration of (10.9 ± 7.3) months,and an average body mass index of (28.9 ± 3.6) kg/m2.In terms of clinical manifestions,majority of the patients presented with headache (n =15) and visual symptoms (n =14),and all with papilledema by fundus examination.The elevated opening cerebrospinal fluid (CSF) pressure was noticed:five cases between 25-33 cmH2O (1 cmH2O =0.098 kPa),11 cases more than 33 cmH2O.The mean pressure difference in the proximal and distal sinus of the anterior chamber was (36.3 ± 9.4) cmH2O in the range of 15-91 cmH2O.The pressure difference between the two ends of the stenosis disappeared immediately after the operation in 12 cases and the pressure difference less than 15 (2-12) cmH2O in four cases.Thirteen patients underwent lumbar puncture at one week after operation.The CSF pressure of them decreased significantly,of which eight were in the normal range.Six months after the operation,11 patients underwent DSA/MRV,none of which had serious surgical complications.With the average follow-up of (35.4 ± 9.8) months,the overall prognosis of these patients was good.Headaches in 14 of 15 patients were improved,out of which 12 were free of headache,two with only mild headache and a slight intracranial hypertension (19 and 23 cmH2O,respectively);visual complaints were reversed in nine out of 14 cases;10 patients underwent fundus examination,and nine of them were observed the improvement of papilledema.During the follow-up period,the symptoms of other patients were improved (headache relief and visual improvement) except one,the overall effective ratio being 15/16.Conclusions The interventional treatment of lateral sinus stenting is effective in patients with sinus stenosis associated with simple intracranial hypertension.The stenosis of the lateral sinus may be the main mechanism of increased intracranial pressure.