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INTRODUCTION: Idiopathic intracranial hypertension (IIH) is a condition characterized by various symptoms such as pulsatile tinnitus, chronic headaches, and papilledema. Venous sinus stenosis has been associated with IIH, and venous sinus stenting (VSS) has emerged as a potential treatment option. However, there is a lack of standardized outcome definitions and limited long-term data on the effectiveness of VSS in current literature. METHODS: In this study, we analyzed the long-term outcomes of 178 patients with medically-refractory IIH who underwent VSS by the senior author. Demographic information, pressure gradients, symptom improvement, recurrence, and persistence were recorded. Quality of life and symptom severity scores were assessed using standardized HIT-6, WHO-BREF, and pulsatile tinnitus surveys. Follow-up duration and patient-reported outcomes were also considered. RESULTS: Among the VSS cohort, 52.8% reported initial symptom relief followed by recurrence, and 13.5% experienced persistent symptoms without improvement. Overall failure rate of VSS was found to be 66.3%. Repeat procedures, such as lumbar puncture or additional stenting occurred in many patients. Survey data showed varying degrees of improvement in symptom severity and quality of life, and these changes were found to be statistically insignificant long-term. CONCLUSIONS: Our study challenges the prevailing notion of favorable outcomes in VSS suggests a need for reevaluation of the procedure as a long-term treatment option for severe IIH. High rates of symptom recurrence, persistence, and the need for repeat interventions indicate limitations in the efficacy of VSS. Improved understanding of the underlying factors contributing to poor outcomes and the development of alternative interventions are essential for better management of this debilitating condition.
Midtlien et al. (Fri,) studied this question.