Endovascular Venous Sinus Stenting for Idiopathic Intracranial Hypertension: A Systematic Review of the Literature

Idiopathic intracranial hypertension (IIH) is characterized by raised intracranial pressure outside the context of space-occupying or obstructive lesions. It is well accepted that most IIH patients have transverse sinus stenosis impairing cerebral venous outflow. Untreated, this may cause optic nerve damage and permanent visual loss. The reported annual incidence is 0.9-1.07/100,000 but may reach 15-19/100,000 in subpopulations of overweight women aged 20-44. Medically refractory IIH has historically been treated by therapeutic lumbar punctures, cerebrospinal fluid (CSF) diversion, and optic nerve sheath fenestration (ONSF). Recurrence rates with medication have reached 40%. Shunt failure and revision rates are as high as 60% with infection-related complications reaching 10%. ONSF carries significant risks with failure rates and concomitant recurrence of visual symptoms up to 32%. Since 2002, venous sinus stenting (VSS) has emerged as an alternative treatment option for refractory IIH.