Brain Stent Eases Pseudotumor Symptoms

A new study shows that an endovascular stent placed in the transverse sinus (TS) significantly reduces the pressure gradient of pseudotumor cerebri (PTC), improving tinnitus as well as visual function.

Researchers at the Uniformed Services University of the Health Sciences (USUHSj Bethesda, MD, USA) and Johns Hopkins University (Baltimore, MD, USA) conducted a study involving 12 patients with PTC. All patients had initial neurological, neuro-ophthalmological, and imaging assessments; regardless of the findings, all were treated with medical therapy. If medical therapy failed and TS stenosis was detected on contrast-enhanced magnetic resonance imaging (MRI) or computerized tomography (CT) venography, catheter cerebral angiography with venous manometry was performed. If a mean pressure gradient of 4 mmHg or greater was present, unilateral TS stenting was performed.

The results showed that TS stenting significantly decreased the PTC pressure gradient in all cases, and that unilateral stenting was sufficient to reduce pressure gradients, even when the stenosis was bilateral. At a mean follow-up of 16 months, tinnitus had improved in all patients, and 10 of 12 patients had improvement in visual function. Seven of the patients also had significant improvement in headaches. The study was published on March 14, 2013, in the Journal of Neuro-Ophthalmology.

“Following stenting, headaches resolved completely in two patients and improved in five, but persisted in the remaining five patients,” concluded lead author Martin Radvany, MD, of USHUS, and colleagues. “Of five patients in this series who continued to have headaches despite normalization of CSF pressure after stenting, four responded to migraine prophylactic medications.”

Pseudotumor cerebri presents as raised intracranial pressure (ICP) with normal cerebrospinal fluid (CSF) analysis, and without clinical or imaging evidence of a space-occupying pathology. Around 10%–20% of patients will experience vision loss caused by prolonged papilledema, with secondary optic nerve atrophy. Conventional treatment consists of oral acetazolamide, which is limited in long-term use by its side effects. Surgical options include optic nerve sheath fenestration and CSF diversion procedures.

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Uniformed Services University of the Health Sciences
Johns Hopkins University