AUTHOR=Oyemade Kafayat A. , Xu Timothy T. , Brinjikji Waleed , Cutsforth-Gregory Jeremy K. , Lanzino Giuseppe , Kallmes David F. , Moss Heather E. , Dodd Robert , Bhatti M. Tariq , Chen John J. 

TITLE=Improved Ophthalmic Outcomes Following Venous Sinus Stenting in Idiopathic Intracranial Hypertension

JOURNAL=Frontiers in Ophthalmology

VOLUME=Volume 2 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/ophthalmology/articles/10.3389/fopht.2022.910524

DOI=10.3389/fopht.2022.910524

ISSN=2674-0826

ABSTRACT=Background: Ophthalmic outcomes following venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH) are not well characterized.

Materials and Methods: Retrospective chart review of 86 consecutive patients with IIH who underwent venous sinus stenting at Mayo Clinic, Rochester, Minnesota and Stanford Medical Center, Palo Alto, California between May 2015 and October 2021. Patients with raised intracranial pressure from a non-IIH etiology were excluded. Clinical symptoms and neuro-ophthalmological data including best corrected visual acuity (BCVA), visual field mean deviation, papilledema, optical coherence tomography (OCT) peripapillary retinal nerve fiber layer (pRNFL), and ganglion cell-inner plexiform layer (GC-IPL) were analyzed. Baseline measurements prior to VSS and 3 months or more postoperatively were compared.

Results: Eighty-six subjects (82 female) were included in this study, with median age 33 (16 - 68) years and median body mass index 36.69 (22.30 – 62.00) kg/m2.  85/86 (98.8%) had attempted prior management with medication and 12/86 (14%) had prior surgical management with optic nerve sheath fenestration, ventriculoperitoneal shunt or bariatric surgery. Prior to VSS, 67/86 (77.9%) had papilledema, 85/86 (98.8%) had headaches, and 68/86 (79.1%) had pulsatile tinnitus. For patients with both pre- and post-VSS data available, the average papilledema grade was 1.76 (0 – 5) (n=74) and the average OCT pRNFL was 186.34 (52.00 – 588.00) µm (n=70), prior to VSS. A median of 4.0 (interquartile range 3.3 – 5.4) months after VSS, the average papilledema grade improved to 0.39 (0 – 2), p<0.001, and OCT pRNFL improved to 96.86 (47.00 – 168.00) µm, p<0.001. 28/86 (32.6%) patients no longer required medication for high intracranial pressure. 14/85 (16.5%) patients reported complete resolution of headache and 55/71 (77.5%) reported improvement in headache quality. 40/68 (66.7%) reported complete resolution of pulsatile tinnitus. OCT GC-IPL, BCVA, and visual field mean deviation did not significantly change pre- vs post-VSS. 

Conclusions: Our large consecutive case series corroborates smaller prior studies in demonstrating the overall efficacy of VSS for patients with IIH. We found both ophthalmic improvements, as demonstrated by the significantly reduced papilledema and pRNFL, and overall clinical symptom improvement.