Introduction Current treatments of Idiopathic Intracranial Hypertension (IIH) include medical management, ventriculoperitoneal shunting and venous sinus stenting. The eShunt implant is a transdural shunt deployed via the inferior petrosal sinus (IPS) to drain CSF from the cerebellopontine angle cistern (CPAC) into the internal jugular vein. Although the eShunt implant has shown promising results in adult patients with normal pressure hydrocephalus, its wide‐ranging applicability in IIH remains undefined. Materials and Methods High‐resolution T1‐weighted Gadolinium‐enhanced brain MRIs of IIH patients collected after venous sinus stenting at our center were analyzed to measure CPAC depth, IPS diameter, IPS angle, and cerebellar tonsillar descent. Endovascular shunt eligibility on either side was established under three anatomic criteria: stringent (CPAC depth >5mm), moderate (CPAC depth >4mm), and permissive (CPAC depth >3mm); IPS diameter >2mm was also required. Results 92 adult patients (ages 18‐77, 78 female) were included. Median CPAC depth was 4.13 mm and 4.11 mm, while median IPS diameter was 3.73 mm and 3.65 mm, for right and left sides, respectively. Mean CPAC depth trended higher, though not significantly, with older age (P=0.12) and male sex (P<0.09), IPS diameter showed no associations, and side variation was insignificant. Endovascular shunting was feasible in 43%, 61% and 78% of analyzed patients, under stringent, moderate, and permissive criteria, respectively. Venous sinus stenting did not impact eligibility. Cerebellar tonsillar descent is inversely correlated with CPAC depth (P<0.005). On excluding patients with low‐lying tonsils <1mm above the foramen magnum, eligibility rose to 65% (ns), 84% (P<0.05) and 97% (P<0.05), under stringent, moderate, and permissive criteria, respectively. Conclusions A significant population of patients with IIH currently treated with venous stenting may be suitable candidates for endovascular shunting. Given its biomechanical potential, minimally invasive nature, and preliminary feasibility, clinical investigation of the eShunt implant for IIH management is warranted. image image
Adel M. Malek (Sat,) studied this question.