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| venous_sinus_stenting_for_idiopathic_intracranial_hypertension_treatment_indications [2025/07/01 13:46] – created administrador | venous_sinus_stenting_for_idiopathic_intracranial_hypertension_treatment_indications [2025/07/01 13:48] (current) – administrador | ||
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| - | ====== Venous | + | ====== Venous |
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| + | ===== I. Core Indications ===== | ||
| + | Venous sinus stenting (VSS) is indicated in selected patients with IIH who meet the following criteria: | ||
| + | |||
| + | * **Refractory IIH**: | ||
| + | * Persistent elevated intracranial pressure (ICP) despite: | ||
| + | * Weight loss | ||
| + | * Medical therapy (e.g., acetazolamide, | ||
| + | * Serial lumbar punctures or temporary CSF diversion | ||
| + | * Progressive or threatened **visual loss** | ||
| + | * Severe or intractable **headache** with features of venous outflow obstruction | ||
| + | |||
| + | * **Radiological Evidence of Venous Sinus Stenosis**: | ||
| + | * Focal stenosis of the **transverse** or **sigmoid sinus** | ||
| + | * Confirmed by: | ||
| + | * CT Venography (CTV) | ||
| + | * MR Venography (MRV) | ||
| + | * Digital Subtraction Angiography (DSA) | ||
| + | |||
| + | * **Hemodynamic Confirmation**: | ||
| + | * Trans-stenotic pressure gradient ≥ **8–10 mmHg** on catheter venography | ||
| + | |||
| + | ===== II. Supportive Findings ===== | ||
| + | These findings are supportive but not mandatory for stenting: | ||
| + | |||
| + | * Venous sinus waveform abnormalities (e.g., “collapsing” or “thumping” waveforms) | ||
| + | * Elevated lumbar puncture opening pressure > 25 cm H₂O | ||
| + | * MRI features: | ||
| + | * Empty sella | ||
| + | * Optic nerve sheath distension | ||
| + | * Flattening of the posterior globe | ||
| + | * Papilledema | ||
| + | * Transient improvement after lumbar puncture | ||
| + | |||
| + | ===== III. Contraindications / Relative Exclusions ===== | ||
| + | |||
| + | * Absence of a measurable trans-stenotic pressure gradient | ||
| + | * Intrinsic stenosis due to arachnoid granulations without pressure gradient | ||
| + | * Uncontrolled hypercoagulable states | ||
| + | * Poor vascular access or unfavorable stent anatomy | ||
| + | * Active CNS infection or inflammation | ||
| + | * Urgent need for rapid CSF decompression | ||
| + | |||
| + | ===== IV. Special Considerations ===== | ||
| + | |||
| + | * **Optic nerve sheath fenestration** may be preferred in isolated visual loss | ||
| + | * **CSF diversion (e.g., ventriculoperitoneal shunt)** may be favored when: | ||
| + | * There is no significant venous stenosis | ||
| + | * Multiple contributing factors exist for ICP elevation | ||
| + | * Rapid clinical deterioration requires urgent decompression | ||