Introduction: Idiopathic intracranial hypertension (IIH) is a difficult neurologic problem to manage with medical and surgical management due to side effects and complications. A subset of patients with dural sinus stenosis has shown benefit with endovascular dural venous sinus stenting (DVSS). It is hypothesized that stenting relieves the stenosis, thereby normalizing the venous pressure gradient, promoting cerebrospinal fluid drainage, ultimately leading to normal intracranial pressure.

Methods: A retrospective study was performed to identify IIH patients with dural sinus stenosis on noninvasive neuroimaging who were treated with DVSS. Outcome measurements included pre- and post-intervention dural venous sinus pressure gradients; optical coherence tomography (OCT) at ophthalmologic examinations; and improvement in clinical symptoms of visual disturbances, headaches, and tinnitus.

Results: Fifteen patients (13 female) were identified who underwent endovascular DVSS. Mean age was 30 years. All patients had pre-procedural lumbar punctures with average opening pressure of 37.3 cmH2O (26-55). Average pre- and post-intervention sinus gradients were 21.93 mmHg and 1.2 mmHg, respectively. Eleven patients noted improvement in headache. Ten patients had visual improvement on follow-up. OCT improved in six patients with stability in three patients. The remaining six patients were either awaiting return ophthalmology appointments or were lost to follow-up. Overall, OCT improvement correlated with improved visual acuity. In addition, two patients with improved visual acuity had stable, normal OCT exams.

Conclusions: Our series of patients with dural venous sinus stenosis treated with endovascular DVSS have well documented improvement in vision and OCT. Use of OCT in outcomes in IIH is an effective method to objectively assess efficacy of stenting. Our series demonstrates good objective and subjective outcomes in IIH patients treated with endovascular DVSS.

Patient Care: Our research on dural sinus stenting shows promise for a relatively new, definitive modality of treatment for idiopathic intracranial hypertension. We plan to continue collecting patients to publish a larger series with these follow-up examinations and objective OCT testing to further evaluate the correlation with outcome. Additionally, this modality of IIH treatment, with further research and follow-up, will hopefully provide long-term results without the side effects of medications or disadvantages of cerebrospinal fluid diversion.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the technique of endovascular dural venous sinus stenting in the treatment of IIH 2) Become acquainted with the technique of OCT for objective retinal examinations 3) Familiarize themselves with preliminary research on dural venous stenting for treatment of IIH and visual function

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