Journal of neurological surgery. Part B, Skull base · 2024
Venous Sinus Stenting for Cerebrospinal Fluid Leaks in Setting of Idiopathic Intracranial Hypertension-An Institutional Series and Systematic Review of Literature.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Lim Jaims, Jaikumar Vinay, Okai Bernard K, Malueg Megan D, Khan Hamid Sharif, Liu Collin, Fritz Alexander, Ghannam Moleca, Levy Elad I, Siddiqui Adnan H, Vakharia Kunal
Аннотация
INTRODUCTION: Chronic cerebrospinal fluid (CSF) pressure in idiopathic intracranial hypertension (IIH) can erode the skull base and cause CSF leaks, necessitating surgical repair or other interventions. Venous sinus stenting (VSS) may restore normal CSF reabsorption and flow, reducing elevated pressures and warranting further investigation as a treatment for IIH-related CSF leaks.
METHODS: We retrospectively reviewed charts of IIH patients who underwent VSS for CSF leak repair, analyzing clinical presentation, imaging, treatment, and follow-up. A systematic review of PubMed and Embase was conducted, with continuous variables reported as medians and interquartile ranges (IQRs).
RESULTS: We included two institutional cases and seven cases from the systematic review. Median age was 51 years (35-53), with eight female and six obese patients. Among six patients with prior confirmed IIH, four of five treated with acetazolamide were refractory. All presented with CSF rhinorrhea, six had a history of leaks, and four were recurrences. Seven had bony dehiscence. All had bilateral venous stenosis with a pressure gradient of 6 mmHg (3-8.25) and underwent unilateral VSS, with one patient also undergoing angioplasty. Over a 12-month follow-up (11-27), leaks resolved in all patients but one within 3 months (0.875-3). Four had recurrences by 7.15 months (4.8-9); one resolved spontaneously, another after angioplasty, and two required ventriculoperitoneal shunting. One patient underwent additional dural grafting for new sphenoid dehiscence, achieving resolution.
CONCLUSION: VSS can be an effective initial treatment for IIH-related CSF leaks; but if VSS does not adequately address underlying intracranial pressures, additional medical and surgical interventions are warranted to prevent recurrent leaks.
METHODS: We retrospectively reviewed charts of IIH patients who underwent VSS for CSF leak repair, analyzing clinical presentation, imaging, treatment, and follow-up. A systematic review of PubMed and Embase was conducted, with continuous variables reported as medians and interquartile ranges (IQRs).
RESULTS: We included two institutional cases and seven cases from the systematic review. Median age was 51 years (35-53), with eight female and six obese patients. Among six patients with prior confirmed IIH, four of five treated with acetazolamide were refractory. All presented with CSF rhinorrhea, six had a history of leaks, and four were recurrences. Seven had bony dehiscence. All had bilateral venous stenosis with a pressure gradient of 6 mmHg (3-8.25) and underwent unilateral VSS, with one patient also undergoing angioplasty. Over a 12-month follow-up (11-27), leaks resolved in all patients but one within 3 months (0.875-3). Four had recurrences by 7.15 months (4.8-9); one resolved spontaneously, another after angioplasty, and two required ventriculoperitoneal shunting. One patient underwent additional dural grafting for new sphenoid dehiscence, achieving resolution.
CONCLUSION: VSS can be an effective initial treatment for IIH-related CSF leaks; but if VSS does not adequately address underlying intracranial pressures, additional medical and surgical interventions are warranted to prevent recurrent leaks.