2026 Poster Presentations
P235: VENOUS SINUS STENTING TIMING FOLLOWING CSF LEAK REPAIR: SAFETY AND OUTCOMES
Peter S Giannaris, BS1; John Schaefer, BS2; Mark Chaskes, MD3; Charles C Tong, MD3; Aron Pollack, MD3; Danielle Golub, MD4; Justin Turpin, MD4; Amir Dehdashti, MD4; Athos Patsalides, MD4; Timothy White, MD4; Judd Fastenberg, MD3; 1City University of New York School of Medicine; 2LSU School of Medicine; 3Department of Otolaryngology- Head and Neck Surgery, Northwell Health; 4Department of Neurosurgery, Northwell Health
Background: Venous sinus stenosis has been increasingly identified as a contributing factor to idiopathic intracranial hypertension (IIH) and associated spontaneous cerebrospinal fluid (CSF) leaks. There is significant evidence demonstrating the efficacy and safety of venous sinus stenting (VSS) for this condition. However, the nuanced integration of this minimally invasive treatment option into the treatment paradigm for IIH and CSF leaks remains largely undefined. This includes the safe and optimal timing of VSS following CSF leak repair, which is an important consideration given the need for pre and post-procedure anticoagulation.
Methods: We retrospectively reviewed 6 patients (5 females, 1 male) treated at our institution between 2020-2025 who underwent surgical repair of spontaneous or encephalocele-related CSF leaks followed by VSS. Clinical records and imaging were analyzed for recurrence, reoperation, meningitis, shunting, stent complications, and symptom outcomes. Patients were stratified by time from repair to stenting: short interval (<70 days, n=3) versus long interval (≥70 days, n=3). Descriptive statistics were used to summarize patient characteristics and outcomes.
Results: The mean age was 48.5 years (range 33-61) with a mean BMI of 43.6 (range 31-67). All leaks were unilateral, occurring at the sphenoid (n=3), cribriform/ethmoid (n=1), temporal tegmen (n=1), and frontal basal (n=1). Four patients had complex defects involving multiple subsites. Encephaloceles/meningoceles were present in 5/6 patients. All patients had symptoms attributable to IIH including headaches (6/6), pulsatile tinnitus (3/6), and visual complaints (3/6). Papilledema was diagnosed in one patient and optic nerve sheath dilation in two others.
Intraoperative confirmation of CSF leak was obtained in all patients. All skull base defects were repaired successfully without recurrent leak or need for reoperation. Reconstruction included multilayer closure with vascularized nasoseptal flaps (n=3), free mucosal grafts (n=2), and fat grafts (n=1). Lumbar drains were used in 5 patients for purpose of fluorescein localization. One patient underwent a middle cranial fossa approach for encephalocele resection.
The median interval from repair to stenting was 62 days (range 39–146). Three patients underwent short-interval stenting (39-54 days), and three underwent long-interval stenting (70–146 days). Median clinical follow-up was 15 months (range 5-57). No patients experienced recurrent CSF leak, meningitis, or required reoperation or shunting after stenting. Headaches improved in 6/6 patients with complete resolution in 2, while all 3 patients with pulsatile tinnitus achieved resolution. Papilledema resolved or stabilized in all patients with ophthalmologic follow-up. There were no bleeding complications following VSS and associated anticoagulation.
Conclusion: VSS following CSF leak repair is safe and effective across both short and long-interval timing. Short-interval VSS did not compromise reconstruction and the need for post procedure anticoagulation did not contribute to bleeding-related complications. These findings support the use of VSS in appropriate patients who present with CSF leaks and evidence of IIH and highlight the need for more research to define its nuanced integration into the treatment paradigm.