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1.
J Neurointerv Surg ; 13(6): 574-579, 2021 Jun.
Article in English | MEDLINE | ID: mdl-32895320

ABSTRACT

BACKGROUND: Idiopathic intracranial hypertension is a disease of raised intra-cranial pressure of unknown etiology. Lateral cerebral venous sinus stenosis (VSS) has been increasingly reported in these patients, and stenting has emerged as an alternative treatment for medically refractory symptoms. Treatment efficacy on meta-analysis appears promising, but identifying which patients are likely to benefit most, and which are likely to require repeat procedures, is currently unclear. METHODS: We retrospectively reviewed a prospectively collected database of 79 patients treated with venous sinus stenting at a single academic center with minimum follow-up of 18 months. We extracted baseline clinical data, as well as manometry at lumbar puncture and during angiography, and used logistic regression to identify parameters that could predict stent failure. RESULTS: Retreatment rate after successful VSS was 13.9%. Lumbar puncture opening pressure (OP) was shown to significantly predict treatment failure (ß=0.06; OR=1.064 (1.003-1.135); P=0.039). This effect remained significant when age, sex and body mass index were added to the model (ß=0.06; OR=1.066 (1.002-1.140); P=0.043). OP was correlated with venous sinus manometry readings in the superior sagittal and transverse sinus pre-stent placement, as well trans-stenotic gradient (P<0.001). CONCLUSIONS: Higher lumbar puncture OP was associated with an increased risk of stent failure in transverse sinus stenting for idiopathic intracranial hypertension, although the performance of this model as a linear discriminator was poor. Further studies are required to better assess which patients are at greatest risk of treatment failure.


Subject(s)
Cranial Sinuses/physiopathology , Cranial Sinuses/surgery , Pseudotumor Cerebri/physiopathology , Pseudotumor Cerebri/surgery , Adult , Body Mass Index , Cerebral Veins/physiopathology , Cerebral Veins/surgery , Female , Follow-Up Studies , Humans , Intracranial Hypertension/diagnosis , Intracranial Hypertension/physiopathology , Male , Manometry/methods , Manometry/trends , Middle Aged , Predictive Value of Tests , Prospective Studies , Pseudotumor Cerebri/diagnosis , Retreatment/methods , Retreatment/trends , Retrospective Studies , Stents/trends , Treatment Outcome
2.
J Neurointerv Surg ; 11(2): 175-178, 2019 Feb.
Article in English | MEDLINE | ID: mdl-29871989

ABSTRACT

AIMS: We report the cerebrospinal fluid opening pressure (CSF-OP) measurements obtained before and after venous sinus stenting (VSS) in 50 patients with idiopathic intracranial hypertension. METHODS: The CSF-OP was measured with a spinal tap 3 months before and 3 months after treatment. All data were prospectively collected and included patient demographics, weight (kg), body mass index (BMI), acetazolamide daily dosage (mg), procedural details, complications, venous sinus pressures (mm Hg), trans-stenotic pressure gradient (mm Hg), transverse sinus symmetry, and type of venous sinus stenosis. RESULTS: The average pretreatment CSF-OP was 37 cm H2O (range 25-77) and the average post-treatment CSF-OP was 20.2 cm H2O (range 10-36), with an average reduction of 16.8 cm H2O (P<0.01). The post-treatment CSF-OP was less than 25 cm H2O in 40/50 patients. The average acetazolamide daily dose decreased from 950 mg to 300 mg at the time of 3-month follow-up (P<0.01). No patient required an increase in acetazolamide dose 3 months after VSS. The average weight before treatment was 95.4 kg with an average BMI of 35.41. There was an average increase in body weight of 1.1 kg at the 3-month follow-up with an average increase in BMI of 0.35 (P=0.03). CONCLUSIONS: We provide evidence that there is a significant decrease in CSF-OP in patients with idiopathic intracranial hypertension 3 months after VSS, independent of acetazolamide usage or weight loss.


Subject(s)
Intracranial Pressure/physiology , Pseudotumor Cerebri/diagnostic imaging , Pseudotumor Cerebri/surgery , Stents , Transverse Sinuses/diagnostic imaging , Transverse Sinuses/surgery , Adolescent , Adult , Body Mass Index , Child , Female , Humans , Male , Middle Aged , Prospective Studies , Pseudotumor Cerebri/physiopathology , Stents/adverse effects , Transverse Sinuses/physiopathology , Venous Pressure/physiology , Young Adult
3.
Surg Neurol Int ; 7(Suppl 42): S1089-S1091, 2016.
Article in English | MEDLINE | ID: mdl-28144491

ABSTRACT

BACKGROUND: There exists an inherent risk of increased venous thromboembolism (VTE) in surgical spine patients, which is independent of their existing risk factors. Prophylaxis and treatment of VTE is an imprecise practice and may have serious complications even well after the initial surgery. Furthermore, there are no clear guidelines on how to manage postoperative spine patients with regards to the timing of anticoagulation. CASE DESCRIPTION: Here, we present the case of a middle-aged male, status post L2/3 laminectomy and discectomy who developed bilateral below the knee deep venous thrombosis. He was started on Enoxaparin and transitioned to Warfarin and returned with axial back pain, and was found to have a postoperative hematoma almost 3 weeks later in a delayed fashion. CONCLUSION: Delayed surgical wound hematoma with neural compression is an important complication to identify and should remain high on the differential diagnosis in patients on warfarin who present with axial spinal pain.

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