Venous Sinus Stenting for Cerebrospinal Fluid Leaks in Setting of Idiopathic Intracranial Hypertension-An Institutional Series and Systematic Review of Literature.

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.