A BSTRACT Background: Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure (ICP) without identifiable intracranial pathology or abnormal cerebrospinal fluid composition. Venous sinus stenosis has been increasingly recognized as a potential contributing factor, and venous sinus stenting (VSS) is emerging as a promising treatment modality for refractory cases. Objective: To evaluate the effectiveness, safety, and clinical outcomes of venous sinus stenting in patients with IIH and radiologically confirmed venous sinus stenosis. Materials and Methods: A prospective observational study was conducted between 2021 and 2024, including patients fulfilling the modified Dandy criteria for IIH with suspected venous stenosis on MRI/MRV. All patients underwent diagnostic cerebral venography with trans-stenotic pressure (TSP) gradient measurement using microcatheter manometry. A pressure gradient ≥10 mmHg was considered significant and taken as a cutoff for stenting. Clinical improvement was assessed using the Numerical Rating Scale (NRS) and Visual Pain Intensity Scale (VPIS) for headache and Frisen grading for papilloedema. Post-stenting follow-up was performed at regular intervals up to one year. Results: Eighteen patients (13 females, 5 males; age range 13–50 years) were evaluated. Eight had a TSP ≥ 10 mmHg, and five underwent stenting with self-expandable open-cell stents across the stenotic segment. All patients demonstrated significant post-procedural improvement in venous flow and reduction in pressure gradient. Clinical outcomes showed marked improvement in headache in 92.8% (13/14) of patients and complete resolution of tinnitus and diplopia. Fundus evaluation revealed regression of papilloedema in all patients within one month of the procedure. MRI/MRV at six months confirmed stent patency with no in-stent thrombosis or adjacent stenosis. No major procedural or antiplatelet-related complications occurred, and all patients remained symptom-free at one-year follow-up. Conclusion: Venous sinus stenting is a safe, effective, and durable treatment option for selected patients with IIH and significant venous sinus stenosis. It provides substantial symptomatic relief, particularly in headaches, visual disturbances, and tinnitus, with excellent safety and long-term outcomes.
Paramasivam et al. (Sat,) studied this question.