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Global collapse of the dural sinuses after venous stenting in idiopathic intracranial hypertension
  1. Alice Kedra1,
  2. Mounir Lahlouh2,3,
  3. Eimad Shotar4,5,
  4. Yasmina Chenoune3,6,
  5. Lucas Boistard1,3,
  6. Alizée Boussac1,3,
  7. Natalia Shor4,5,
  8. Julien Savatovsky1,
  9. Rabih Hage7,
  10. Valérie Touitou5,8,9,
  11. Patrick Nicholson10,
  12. Frédéric Clarençon4,9,11,
  13. Michel Piotin1,
  14. Raphaël Blanc1,
  15. Stephanie Lenck4,5,9
  1. 1 Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
  2. 2 CReSTIC EA 3804, Université de Reims Champagne Ardenne, Reims, Grand Est, France
  3. 3 Ecole ESME Sudria, Ivry-sur-Seine, France
  4. 4 Neuroradiology, Groupe Hospitalier La Pitié Salpêtrière-Charles Foix, Paris, Île-de-France, France
  5. 5 GRC E-HTIC, Sorbonne University, Paris, Île-de-France, France
  6. 6 LISSI (EA 3956), UPEC, Creteil, Île-de-France, France
  7. 7 Ophtalmology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, Île-de-France, France
  8. 8 Ophtalmology, Groupe Hospitalier La Pitié Salpêtrière-Charles Foix, Paris, Île-de-France, France
  9. 9 Sorbonne University, Paris, France
  10. 10 Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
  11. 11 GRC BioFast, Paris VI University, Paris, France
  1. Correspondence to Dr Stephanie Lenck, Neuroradiology, Groupe Hospitalier La Pitié Salpêtrière-Charles Foix, Paris, Île-de-France, France; stephanie.lenck{at}orange.fr

https://doi.org/10.1136/jnnp-2020-325717

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    Introduction

    Lateral sinus stenoses (LSS) may represent the macroscopic evidence of the microscopic restriction in the venous CSF outflow pathway in idiopathic intracranial hypertension (IIH).1 These stenoses seem to play a crucial role in maintaining and/or triggering the ‘vicious cycle’ of IIH. By restoring a physiological pressure gradient between the venous system and the subarachnoid space, venous sinus stenting (VSS) allows us to break this cycle and in many cases effectively relieve the symptoms related to elevated intracranial pressure (ICP). However, IIH symptoms may recur in about 10% of patients.2 In most of these relapsed cases, a stenosis of the stent-adjacent ipsilateral transverse sinus and/or of the proximal third of the superior longitudinal sinus (SLS) is found, which seems to retrigger the pathological loop of IIH. The serial changes in the appearances of the venous system after VSS in asymptomatic or mildly symptomatic patients have never been evaluated in the literature.

    Method

    With our institutional review board approval (IRB: CRM-2001-055), we retrospectively collected the clinical and radiological features of consecutive patients treated with VSS for IIH from January 2013 to December 2019 in our two tertiary-referral institutions. Inclusion criteria were adult patients who underwent VSS for IIH refractory to/with contraindications to medical therapy. All patients underwent a brain 3T-MRI with contrast-enhanced MR venography before and 3–6 months after stent placement. A conventional digital subtracted angiography with venous manometry was performed prior to stent placement under local anaesthesia. The area of the lumen of the dural sinuses, their minimal diameter (online supplemental figures 1 and 2) and their volume (online …

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    Footnotes

    • Contributors All coauthors met the following authorship criteria: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; final approval of the version published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests FC reports conflicts of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (payment for readings; non-related to the study), Codman Neurovascular and Microvention (core lab; non-related to the study).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.