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Treatment / Venous Sinus Pressure Measurements and Stenting

In some patients with idiopathic intracranial hypertension (IIH), the normal absorption of cerebrospinal fluid into the veins of the brain is impaired due to a narrowing of the venous sinuses, passageways that convey blood and CSF from the brain to the jugular veins and eventually to the heart. The narrowing of these passageways over time can increase pressure inside the skull and eyes causing IIH.

Am I a Candidate for Venous Sinus Pressure Measurements and Stenting?

If weight loss and medication have not controlled your IIH, your doctor may recommend a contrast enhanced MR venogram or contrast enhanced CT venogram to see if there is a narrowing in your venous sinuses. If so, the next step is referral to an interventional neuro-radiologist to see if you might benefit from having a stent placed in the vein to open up the narrowing.

What to Expect from the Procedure

The goal of venous sinus pressure measurements and stenting is to identify and open up a narrowing in the venous sinus. This allows blood to pass through more easily, and reduce the build-up of pressure inside the head.

The procedure is performed under anesthesia or sedation. First, your interventional neuro-radiologist will conduct a conventional cerebral angiogram to look for any misshapen blood vessels that can be contributing to your IIH. The angiogram involves using a small catheter to examine cerebral blood flow and the specific location of the blood vessels inside your head.

Next, the doctor will measure the pressure gradient across the narrowing in the veins. A stent is only appropriate if the narrowing in your blood vessel causes a pressure gradient.

A stent is a small tube made of wire mesh; this tube is inserted in to the venous sinus under image guidance and expanded across the narrowed part to hold it open.

Recovery

After venous sinus stenting, some patients have a different type of headache on one side of the head, near to where the stent has been placed. If this happens, most people report improvement within a few weeks. Occasionally, there can be hearing loss and dizziness on one side, but this usually resolves quickly and completely. The goal of venous sinus stenting is to prevent blindness from the increased pressure in the eye. The added benefit is that it may also help with your headaches.

You will be required to take blood thinners starting a few days before the procedure and continue for several months afterward to prevent clots from forming on the stent.

How Effective is Venous Sinus Stenting?

Venous sinus stenting is a relatively new treatment option. It is typically recommended for patients who have tried other medical and surgical options and are still experiencing symptoms.

Early outcomes data show that for every 10 people treated, around 8 patients report an improvement in either some or all of their symptoms. Some patients have complete relief of symptoms.

What are the Risks?

While generally very safe, potential complications include those related to anesthesia as well as complications related to cerebral angiography and stenting. The procedural risks include the stent clotting, bleeding, and rarely stroke, or bleeding into the brain.

If you have been diagnosed with idiopathic intracranial hypertension and are exploring your options for treatment, call IVC today at 503-612-0498 to schedule an appointment for consultation.

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