1002. Unique Variant of Idiopathic Intracranial Hypertension Dural Sinus Stenting

Authors: Anthony Alvarado, MD; Michael Abraham, MD; Andrew Alvarado (Kansas City, KS)

Introduction: Venous sinus stenting has emerged as a therapeutic option for idiopathic intracranial hypertension (IIH) in a subset of patients who demonstrate evidence of venous sinus stenosis on cerebral venography, resulting in cerebral venous outflow impediment. We present a unique case of IIH secondary to venous sinus stenosis due to a persistent occipital-marginal sinus (POMS), which functioned as the main venous outflow tract. Methods: A 55-year-old female presented with headaches and blurry vision. Ophthalmologic examination demonstrated papilledema. Two lumbar punctures demonstrated opening pressures of 31 and 38 cmH2O and provided temporary symptom relief. Cerebral venography demonstrated hypoplastic bilateral transverse-sigmoid sinuses with dominant drainage through a persistent occipital-marginal sinus (POMS) associated with focal stenosis and an 18 mmHg mean pressure gradient. Given minimal improvement with acetazolamide therapy, the patient elected for endovascular dural sinus stenting of the dominant, persistent occipital-marginal sinus. Results: Immediate post-stenting venography demonstrated resolution of the POMS stenosis with flow only into the POMS and a mean pressure gradient across the stenosis normalized to 2mmHg. Post-operatively the patient reported symptom resolution and ophthalmologic exam demonstrated resolution of papilledema. Six-month follow-up venography demonstrated continued stent patency and clinical symptoms remained resolved. At 18 months the patient remained asymptomatic. Conclusion: Endovascular intervention in the form of dural sinus stenting has developed as an encouraging treatment modality for IIH patients with documented venous sinus stenosis. This writing summarizes the utility of endovascular dural sinus stenting and the importance of recognizing the dominant dural sinus drainage route in the treatment of IIH.