Semin intervent Radiol 2020; 37(02): 175-181
DOI: 10.1055/s-0040-1709172
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Idiopathic Intracranial Hypertension: Contemporary Management and Endovascular Techniques

David Case
1  Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
,
Joshua Seinfeld
1  Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
,
Christopher Roark
1  Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
,
David Kumpe
2  Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

Publication Date:
14 May 2020 (online)

Abstract

Idiopathic intracranial hypertension (IIH) is a disease process of abnormally increased intracranial pressure in the absence of a mass lesion. Medical management, optic nerve fenestration, and surgical shunting procedures have failed to produce consistently successful results. In an unknown percentage of cases, IIH is caused by dural venous sinus obstruction which can be cured by endovascular treatment with dural venous sinus stent placement. This helps prevent progressive vision loss and worsening papilledema caused by underlying increased intracranial pressure from venous outflow obstruction. Patients are required to have an established diagnosis of IIH, preferably made by a neuroophthalmologist, with clearly documented papilledema or at minimum visual disturbance along with lumbar puncture opening pressure greater than 25 cm H2O. Transverse to sigmoid sinus focal narrowing (intraluminal filling defect or extrinsic compression) must be seen during the venous phase of neuroangiography (NA) along with a pressure gradient of 10 mm Hg or greater across the focal narrowing during dural venous sinus pressure monitoring. A successful reduction is defined as a pressure gradient of less than 10 mm Hg after stent placement. Neuroophthalmologic follow-up occurs within 1 to 2 months to assess for changes in papilledema. If papilledema is unchanged or worsened, NA and hemodynamic evaluation is repeated for consideration of restenting. Appropriate patient selection criteria are required for IIH venous sinus stenting. The utilization of refined endovascular techniques along with postprocedure follow-up protocols can ultimately cure IIH for a select group of patients.