静脉窦内支架成形术治疗特发性颅高压合并颅内静脉窦狭窄的单中心随访研究

Intravenous sinus stenting for the treatment of idiopathic intracranial hypertension complicated with venous sinus stenosis:a single-center follow-up study

目的 探讨颅内静脉窦内支架成形术治疗特发性颅高压(IIH)合并颅内静脉窦狭窄(CVSS)的疗效.方法 回顾性分析2012年12月至2021年12月河南省人民医院介入治疗中心脑血管病区收治的26例IIH伴局限性CVSS患者的临床资料.所有患者均接受颅内静脉窦内支架成形术治疗.术后行临床随访,观察颅内压的变化情况、患者的临床症状改善情况、有无并发症和新发症状.通过影像学随访评估支架内及支架旁的血流通畅情况.结果 26例患者的技术成功率为100%.术中共置入27枚支架,术后即刻造影显示静脉窦狭窄消失.术后原狭窄处的压力梯度较术前明显下降(中位压力梯度分别为0、14 mm Hg,1 mm Hg=0.133 kPa,P<0.001).术前的耳鸣症状(3例)均消失,头痛(14例)及视力障碍(23例)均有不同程度改善.无一例出现支架内血栓形成或颅内出血等严重并发症.4例(15.4%,4/26)有短暂性支架置入侧头痛,于支架置入后3~5 d内消失.术后3个月,26例患者中,高颅压2例,颅内压偏高6例,颅内压正常18例;与术前(高颅压26例)比较,差异具有统计学意义(P<0.001).26例患者获得中位时间为52.5个月(5~116个月)的临床随访,原有症状均无复发,未出现新发神经功能缺损症状;其中行眼底及视野检查的22例患者的视盘水肿均消失,12例(54.5%)视野好转,10例(45.5%)视野恢复正常.17例患者完成影像学随访,中位随访时间为4个月(3~7个月),所有患者的颅内静脉窦均通畅,支架形态、位置良好,无支架内或支架旁再狭窄.结论 静脉窦内支架成形术治疗IIH、矫正CVSS有效,并发症较少,总体随访效果满意.

Objective To investigate the therapeutic efficacy of intracranial venous sinus stenting for the treatment of idiopathic intracranial hypertension(IIH)complicated with cerebral venous sinus stenosis(CVSS).Methods A retrospective analysis was conducted on the clinical data of 26 patients with IIH accompanied by limited CVSS who were admitted to the Cerebrovascular Department of Interventional Center of Henan Provincial People's Hospital from December 2012 to December 2021.All patients underwent intracranial venous sinus stenting.Clinical follow-up was performed to measure intracranial pressure(ICP)and observe the improvement of clinical symptoms and whether there were complications or new symptoms.Postoperative imaging follow-up was performed to evaluate the patency of blood flow in and beside the stent.Results The technical success rate of surgical procedures in 26 patients was 100%.A total of 27 stents were implanted in the operation,and immediate postoperative angiography showed that venous sinus stenosis disappeared.The pressure gradient in the original stenosis decreased significantly after surgery(median gradient:0 us.14 mm Hg,1 mm Hg=0.133 kPa,P<0.001).Preoperative tinnitus in 3 cases disappeared,headache in 14 cases and visual impairment in 23 cases were relieved to varying degrees.No serious complications such as stent thrombosis or intracranial hemorrhage occurred.Four cases(4/26,15.4%)had transient unilateral headache on the side of surgery,which disappeared within 3-5 days.At 3 months post surgery and among the 26 patients,2 cases had high ICP,6 cases had slightly high ICP,and 18 cases had normal ICP,which was statistically different from preoperative conditions(26 cases with high ICP)(P<0.001).Twenty-six patients were followed up for a median duration of 52.5 months(5-116 months).None of the patients had recurrence of original symptoms and no new symptoms of neurological impairment were reported during follow-up.No optic disc edema was found in 22 patients who underwent fundus and visual field examination.There were 12 patients(54.5%)showing improved visual field and 10 patients(45.5%)having normal visual field.Imaging follow-up was completed in 17 patients,with a median follow-up time of 4 months(3-7 months).The results showed that none of the 17 patients had obstructed intracranial venous sinuses,good stent shape and location were demonstrated,and there was no restenosis in or around the stent.Conclusion Venous sinus stenting seems effective for the treatment of IIH and correction of CVSS with few complications and satisfactory follow-up results.