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Research ArticleNeurointervention
Open Access

Evolution of MRI Findings in Patients with Idiopathic Intracranial Hypertension after Venous Sinus Stenting

N.F. Belachew, W. Almiri, R. Encinas, A. Hakim, S. Baschung, J. Kaesmacher, T. Dobrocky, C.J. Schankin, M. Abegg, E.I. Piechowiak, A. Raabe, J. Gralla and P. Mordasini
American Journal of Neuroradiology October 2021, DOI: https://doi.org/10.3174/ajnr.A7311
N.F. Belachew
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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W. Almiri
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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R. Encinas
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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A. Hakim
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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S. Baschung
fFaculty of Medicine (S.B.), University of Bern, Bern, Switzerland
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J. Kaesmacher
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
bDepartment of Diagnostic, Interventional and Pediatric Radiology (J.K.)
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T. Dobrocky
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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C.J. Schankin
cDepartment of Neurology (C.J.S.)
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M. Abegg
dDepartment of Ophthalmology (M.A.)
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E.I. Piechowiak
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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A. Raabe
eDepartment of Neurosurgery (A.R.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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J. Gralla
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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P. Mordasini
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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  • FIG 1.
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    FIG 1.

    A, Posterior globe flattening (white line), optic nerve protrusion (red arrows), and distension of the optic nerve sheath diameter (white line with arrowheads) in the right eye. B, Measurement technique applied to quantify the empty sella (white line with arrowheads). C, Measurement of the Meckel cave: The circled gray area highlights the width measurement (white line with arrowheads) on the right side. D, Standard measurement to assess cerebellar ectopia (white line with arrowheads). E, Measurement of the distance between the anterior horns of the lateral ventricles (red line with arrowhead) as well as the diameter of the third ventricle corpus (red arrows pointing to perpendicular red lines delimiting the third ventricle corpus). F, Measurement of the frontal and occipital subcutaneous fat (red lines). G, Anatomic course of the occipital emissary vein.

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    FIG 2.

    Axial reformation of both eye globes as well as sagittal reformation of the left eye globe along the axis of the optic nerve before (upper images) and after (lower images) stent placement. Before venous sinus stent placement, there is flattening of the posterior sclera (yellow line) with intraocular protrusion of the optic nerve (blue arrows) and distension of the optic nerve sheath diameter due to increased perineural fluid (red arrows). None of these 3 signs are seen after venous sinus stent placement.

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    Table 1:

    Demographics and comorbiditiesa

    Data Available for % (No.)
    Age100% (13/13)26.9 (23.3–35.3)
    Sex (female) (%)100% (13/13)100% (13)
    Comorbidities
     Diabetes mellitus100% (13/13)15.4% (2)
     Arterial hypertension100% (13/13)23.1% (3)
     Body mass index100% (13/13)28.9 (25.6–36.2)
     Obesity100% (13/13)
      None15.4% (2)
      Moderate38.5% (5)
      Severe46.2% (6)
    • ↵a Data are expressed as percentages (No.) or median (interquartile range [25%–75%]).

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    Table 2:

    Therapy and symptoms before and after venous sinus stent placementa

    Before Venous Sinus Stent PlacementAfter Venous Sinus Stent Placement
    Data Available (%) (No.)Data Available (%) (No.)
    Headache intensity (VAS)84.6% (11/13)7 (5.5–9.0)Headache intensity (VAS)84.6% (11/13)0 (0–0)
    Headache intensity improvement (VAS)84.6% (11/13)−7 (−9 to −4.5)
    Headache, frequency (per wk)84.6% (11/13)7 (4.5–7)Headache frequency (per wk)84.6% (11/13)0 (0–0)
     ≤115.4% (2) ≤184.6% (11)
     2–40.0% (0/0) 2–40.0% (0)
     >469.2% (9) >40.0% (0)
    Patients with >1 type of headache84.6% (11/13)46.2% (6)Headache frequency improvement (per wk)84.6% (11/13)−7 (−7 to −4.5)
    Nausea/emesis100% (13/13)61.5% (8)Nausea/emesis IMP-AF100% (8/8)100% (8)
    Photophobia/phonophobia100% (13/13)23.1% (3)Photophobia/phonophobia IMP-AF100% (3/3)100% (3)
    Tinnitus100% (13/13)61.5% (8)Tinnitus IMP-AF100% (8/8)75.0% (6)
    Diplopia100% (13/13)23.1% (3)Diplopia IMP-AF100% (3/3)100% (3)
    Visual disturbances100% (13/13)69.2% (9)Visual disturbances IMP-AF100% (9/9)88.9% (8)
    Papilledema100% (13/13)69.2% (9)Papilledema IMP-AF88.9% (8/9)88.9% (8)
    Daily life impairment84.6% (11/13)84.6% (11)Daily life quality IMP-AF100% (11/11)100% (11/11)
    Symptom duration (mo)100% (15/15)23.6 (7.3–52.1)Follow-up period (mo)100% (13/13)16.6 (7.8–32.2)
    Other therapy
     Conservative therapy100% (13/13)92.3% (12)
     Duration of conservative therapy (in months)100% (15/15)18.9 (6–26)
     Surgical therapy100% (15/15)7.7% (1)
    • Note:—HA indicates headache; IMP-AF, improvement among affected.

    • ↵a Data are expressed as percentages (No.) or median (interquartile range [25%–75%]).

    • View popup
    Table 3:

    Pressure values before and after venous sinus stent placementa

    BeforeAfter
    Data Available (%) (No.)Data Available (%) (No.)
    CSF opening pressure (cm H2O)84.6% (11/13)31 (23–38)CSF opening pressure (cm H2O)76.9% (10/13)21 (18.75–29.25)
    CSF opening pressure improvement (mm Hg)76.9% (10/13)−9.25 (−20.7 to −5.7)
    Transstenotic pressure gradient in GA (mm Hg)100% (13/13)9 (5–15)Transstenotic pressure gradient in GA (mm Hg)100% (13/13)1 (0–2)
    Transstenotic pressure gradient improvement (in mm Hg)100% (13/13)−8 (−15 to −3.5)
    Transstenotic pressure gradient on diagnosis in LA (mm Hg)92.3% (12/13)22.5 (13.25– 26.25)Transstenotic pressure gradient at 6-mo follow-up in LA (mm Hg)92.3% (12/13)1.5 (0.25– 5)
    Transstenotic pressure gradient improvement at 6-mo follow-up (mm Hg)92.3% (12/13)−19 (−21.75 to −13.25)
    • Note:—LA indicates local anesthesia; GA, general anesthesia.

    • ↵a Data are expressed as percentages (No.) or median (interquartile range [25%–75%]).

    • View popup
    Table 4:

    IIH-related MR imaging findings before venous sinus stent placement and at 6-month follow-upa

    MR Imaging FindingsEvaluation Possible (%) (No.)Before Venous Sinus Stent PlacementAt 6-Month Follow-UpP Values
    Meckel cave (mm)100% (26/26)4.3 (4.0–4.9)4.1 (3.4–5.1).096
    Empty sella (mm)100% (13/13)4.9 (3.5–6.9)4.9 (3.2–7.0).753
    Tonsillar ectopia (mm)100% (13/13)−1.1 (−1.9 to –1.9)−0.67 (−1.3 to −0.9).600
    Lateral ventricles (mm)100% (13/13)31.5 (29.4–34.6)32.2 (29.7–34.6).124
    Third ventricle corpus (mm)100% (13/13)3.7 (3.2–4.2)4.5 (3.5–5.2).075
    Optic nerve sheath diameter (mm)100% (26/26)6.8 (6.2–7.3)6.1 (5.9–6.5).000
    Optic nerve protrusion (%)100% (26/26)
    Posterior globe involvement (%)100% (26/26).001
    Normal convexity of the optic globe38.5% (10)84.6% (22)
    Posterior globe flattening30.8% (8)15.4% (4)
    Posterior globe flattening with optic nerve protrusion30.8% (8)0.0% (0)
    Extracranial findings
     Proximal emissary vein (mm)84.6% (11/13)1.6 (0.6–2.3)1.6 (0.6–2.4).790
     Subcutaneous fat thickness in the scalp (mm)100% (13/13)4.1 (3.8–4.3)4.1 (3.5–4.6).834
     Subcutaneous fat thickness in the neck (mm)100% (13/13)8.9 (7.3–11.2)7.4 (5.9–8.3).001
    • ↵a Data are expressed as percentages (No.) or median (interquartile range [25%–75%]).

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N.F. Belachew, W. Almiri, R. Encinas, A. Hakim, S. Baschung, J. Kaesmacher, T. Dobrocky, C.J. Schankin, M. Abegg, E.I. Piechowiak, A. Raabe, J. Gralla, P. Mordasini
Evolution of MRI Findings in Patients with Idiopathic Intracranial Hypertension after Venous Sinus Stenting
American Journal of Neuroradiology Oct 2021, DOI: 10.3174/ajnr.A7311

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Evolution of MRI Findings in Patients with Idiopathic Intracranial Hypertension after Venous Sinus Stenting
N.F. Belachew, W. Almiri, R. Encinas, A. Hakim, S. Baschung, J. Kaesmacher, T. Dobrocky, C.J. Schankin, M. Abegg, E.I. Piechowiak, A. Raabe, J. Gralla, P. Mordasini
American Journal of Neuroradiology Oct 2021, DOI: 10.3174/ajnr.A7311
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