1137. Management of Spontaneous Skull Base Cerebrospinal Fluid Leak in Patients with Idiopathic Intracranial Hypertension with Dural Venous Sinus Stenting

Authors: Aqib H. Zehri, MD; Kyle Fargen, MD; Robert Townsend, MD (Waughtown, NC)

Introduction:

Dural venous sinus stenting (VSS) has been demonstrated as an effective alternative treatment of Idiopathic intracranial hypertension (IIH).These patients can have spontaneous skull base cerebrospinal fluid (CSF) leak due to high intracranial pressures. Traditional management include methods to lower intracranial pressure with medical therapy or CSF diversion. The aim of this study is to examine the efficacy of VSS in patients with CSF leaks due to IIH.

Methods:

We performed a retrospective analysis of patients with diagnosis of IIH and spontaneous skull base CSF leak associated with venous sinus stenosis, demonstrated by venography,that were treated with VSS. 

Results:

6 patients were identified after retrospective chart review with IIH induced CSF leak with venous sinus stenosis treated with VSS.The average age and BMI was 42.5 years old and 38.6, respectively. One patient had two prior skull base repairs and one had prior right transverse sinus stenting with in-stent stenosis.Four patients had pre-procedure lumbar punctures that demonstrated an average opening pressure of 32.5 mmHg.Pre-stenting venogram was performed to evaluate central venous pressure and venous sinus stenosis demonstrated by a transvenous pressure gradient.Average central venous pressure was 33.6 mmHg and transvenous pressure gradient was 13.8 mmHg.At their most recent follow up, two patients had resolution of their CSF leak and two patients had improved leakage.Two patients had unresolved CSF leak due to persistent but improved high intracranial pressure,one of which had a skull base repair for definitive treatment and one who may require shunting.

Conclusion:

Patients with IIH associated CSF leak can have an angiogram/venogram performed to assess for elevated intracranial pressure and presence of venous sinus stenosis.These patients may benefit from VSS as an alternative treatment to shunting procedures as an initial or adjunct treatment of intracranial hypertension in patients with IIH associated CSF leak and venous sinus stenosis