静脉窦支架治疗难治性颅内压增高——神经眼科评估及预后

Venous sinus stenting for treatment of refractory pseudotumor cerebri syndrome:neuro-ophthalmologic evaluation and outcomes

目的评估静脉窦支架(VSS)用于治疗国人难治性大脑假瘤综合征(PTCS)患者的疗效及安全性。方法单中心队列研究。纳入2019年3月—2022年6月在复旦大学附属眼耳鼻喉科医院神经眼科中心就诊的难治性PTCS患者并行VSS手术评估。收集患者人口学资料、术前及术后神经眼科检查包括视功能及光学相干层析成像(OCT)。结果共纳入评估患者11例(22眼),其中男性4例、女性7例,平均年龄为(50.00±11.88)岁(28~73岁),平均体重指数(BMI)为(24.67±2.36)kg/m2(21.8~28.0 kg/m2)。10例患者首诊表现为一过性视物模糊及耳鸣,3例患者头痛。术后8例患者视乳头水肿程度及视功能显著改善;3例高颅压晚期患者视神经萎缩及视功能稳定无进展。术后视盘周围神经纤维层(RNFL)厚度明显减低,而黄斑节细胞内丛状层复合体(GCIPL)稳定,未发现严重术后并发症。结论VSS用于治疗难治性PTCS有效且安全性好,尤其是早期行手术治疗。OCT测量GCIPL有助于预测疾病进展及预后。

Objective To evaluate the efficacy and safety of venous sinus stenting(VSS)for the treatment of refractory pseudotumor cerebri syndrome in Chinese people.Methods This is a retrospective single-center cohort study.Patients with medically refractory PTCS who underwent VSS from March 2019 to June 2022 at the neuro-ophthalmology division in the Eye&ENT Hospital of Fudan University were enrolled.Demographic data and neuro-ophthalmological clinical characteristics including visual outcomes,papilledema and optical coherence tomography(OCT)were collected.Results Eleven patients(22 eyes)were assessed in this study(4 males and 7 females;mean age:50.00±11.88 with range of 28–73 years;mean BMI:24.67±2.36 with range of 21.8–28.0 kg/m2.Ten patients presented with transient visual obscuration and tinnitus,whereas three had headaches.After surgery,the degree of papilledema and visual function were improved dramatically in eight patients,and the degree of optic atrophy and visual function were stabilized in three patients with advanced optic atrophy.The thickness of peripapillary retinal nerve fiber layer(RNFL)decreased after surgery,whereas the macular ganglion cell inner plexiform layer complex(GCIPL)kept stabilized.There were no severe complications after VSS surgery.Conclusions VSS was effective and safe for the treatment of medically refractory PTCS,especially during early stages the disease.Optical coherence tomography measurement of the GCIPL was useful for predicting the prognosis of refractory PTCS after surgery.