Dural venous sinus stenting in patients with idiopathic intracranial hypertension: report of outcomes from a single-center prospective database and literature review

Introduction: Idiopathic intracranial hypertension (IIH) is a disease of excess cerebrospinal fluid (CSF) leading to rising intracranial pressure. Patients most commonly present with headache, tinnitus, papilledema, and vision loss. It most commonly affects young overweight females, a growing population. Traditional management has consisted of weight loss, medical management, surgical CSF diversion, and optic nerve sheath fenestration. In recent years, cerebral venous sinus stenosis has been described as an almost ubiquitously present potentiator of this disease. Venous sinus stenting to normalize cerebral venous outflow has emerged as a highly effective treatment. Areas covered: In this review, the authors review the epidemiology and pathophysiology of IIH, as well as its common management strategies. The authors focus on the emergence of venous sinus stenting as a safe, effective, and minimally invasive strategy for managing IIH. Expert opinion: IIH caused by venous sinus stenosis can be treated effectively and safely with endovascular stenting of the sinus. Given its low morbidity and failure rate relative to other traditional management strategies, evaluation for venous sinus stenosis should be pursued in this patient population, and referral to a neuro-endovascular specialist made if indicated.