2026 Poster Presentations
P267: VENOUS SINUS STENTING FOR IIH WITH SPONTANEOUS CSF LEAK: TWO OR MORE YEAR PAIRED OUTCOMES FROM A SINGLE-CENTER COHORT
Emma J Anisman, BA; Abdulghafoor Alani, BS; Emma Tam, BA; Shreya Mandloi, MD; Michael R Gooch, MD; Benjamin F Bitner, MD; Marc Rosen, MD; Mindy Rabinowitz, MD; Elina Toskala, MD, PhD, MBA; James J Evans, MD; Gurston Nyquist, MD; Thomas Jefferson University
Background: Elevated intracranial pressure, often attributable to idiopathic intracranial hypertension (IIH), is a known risk factor for spontaneous cerebrospinal fluid (sCSF) leak. After surgical repair of CSF leak, management strategies exist for patients with underlying IIH, including lifestyle modifications, medications, ventriculoperitoneal shunt (VPS), and, more recently, venous sinus stenting (VSS). VSS is an alternative to VPS and is increasingly used for IIH with sCSF leak. We have previously reported short-term patient-reported outcomes after VSS for IIH with sCSF leak, yet there is limited long-term data on its impact on patient symptoms and quality of life.
Objective: To evaluate paired pre- versus post-stent changes in symptoms, treatment dependence, and need for CSF diversion among patients with IIH and spontaneous CSF leak.
Methods: This study updates a previously reported 6-month cohort of patients with IIH and sCSF leak who underwent VSS between January 2022 and August 2023. Retrospective chart review of paired binary endpoints (headache, tinnitus, vision symptoms, papilledema, acetazolamide use, post-stent VPS) at mean 2.89-year follow-up was performed. A composite measure of success assessing the number of patients who required neither acetazolamide nor VPS post-stent was also explored. Paired comparisons used McNemar’s exact test.
Results: Ten patients were included. Nine underwent closure of sCSF leak prior to stent placement, and one patient was treated with VSS alone. The number of patients with each outcome before and after stenting was as follows: headache in 8/10 (80%) before vs 6/10 (60%) after (improved 2, worsened 0; McNemar p=0.50); tinnitus in 7/10 (70%) before vs 1/10 (10%) after (improved 6, worsened 0; p=0.031); vision symptoms in 5/10 (50%) before vs 2/10 (20%) after (improved 5, worsened 2; p=0.45); papilledema in 3/4 (75%) before vs 0/4 (0%) after (improved 3, worsened 0; p=0.25); and acetazolamide use in 8/10 (80%) before vs 4/10 (40%) after (5 discontinued, 1 initiated; p=0.22). VPS after stenting occurred in 3/10 (30%). In the 6/10 patients with persistent headache, 3 received VPS, 1 required neurology referral, and 2 deemed symptoms manageable without further intervention. A composite success (off acetazolamide and no post-stent VPS) was achieved in 6/10 (60%). Patients who required VPS were older on average than those who did not (53.7 vs 42.0 years respectively). No evidence of post-treatment sCSF leak was observed.
Conclusions: In IIH leak patients with sCSF leak, VSS was associated with sustained reductions in tinnitus at 2-3 years post-stent. Though vision symptoms, headache, and acetazolamide dependence improved for some patients, symptoms worsened in others, with 30% requiring VPS. Though this study is limited by its small sample size, these data support the durability of VSS in clinically significant symptom reduction for select patients and justify the need for further study of VSS for sCSF leak.