Dados do Trabalho

Título

Transverse sinus angioplasty (TSA) with stent to refractory Idiopathic Intracranial Hypertension.

RESUMO

Case:
Idiopathic intracranial hypertension (IIH) is a relatively uncommon syndrome, but in recent years its prevalence has been increasing. Our group analyzed data from six patients, mean age of 33.5 years, with refractory IIH treated in a tertiary neurology center. They had poor response to pharmacological treatment and were submitted to a transverse sinus angioplasty (TSA). The time from symptoms onset to interventionist treatment varied from 14 days to 4 years. The general technique was transverse sinus stenting but a sigmoid sinus stent was also implanted in one of the cases. Three patients had pain relief varying between 1 to 2 days after the procedure with drugs subsequently withheld. The other three persisted with pain and it was necessary to maintain medications. Two of them had an immediate response, but the pain returned with the same intensity before the procedure. One of them had headache immediately after the procedure.
Discussion: Although the IIH physiopathology did not have been completely elucidated and multifactorial mechanisms are proposed, there is a clear association with obesity and female gender. Recently, it has been observed that transverse sinus stenosis is a prevalent finding in these patients, but it is not known if it has a causal relationship with elevation of intracranial pressure or if this finding is a consequence of that.
The treatment is based on weight loss and drugs that reduce production or increase drainage of cerebrospinal fluid. The aim is to reduce intracranial pressure, relieve headache and avoid visual loss. TSA with stent has been pointed out as an option for refractory cases in which transverse sinus stenosis with hemodynamic repercussion (pressure gradient greater than 7mmHg) is confirmed by venography.
Conclusion: In refractory IHH with confirmed dural sinus stenosis, angioplasty with stent placement has been suggested as an effective therapy. Published meta-analyses consider significant symptom relief - improvement of up to 90% of papilledema, 80% of visual symptoms, and 80% of headache. Our case series showed symptom benefits in only 50% of patients. However, in patients who responded to therapy, the response was dramatic and allowed to suspend the pharmacological therapy.

Palavras Chave

Idiopathic Intracranial Hypertension, Dural sinus stenosis, Angioplasty, Stent, Headache