Global collapse of the dural sinuses after venous stenting in idiopathic intracranial hypertension.

Lateral sinus stenoses (LSS) may represent the macroscopic evidence of the microscopic restriction in the venous CSF outflow pathway in idiopathic intracranial hypertension (IIH).1 These stenoses seem to play a crucial role in maintaining and/or triggering the ‘vicious cycle’ of IIH. By restoring a physiological pressure gradient between the venous system and the subarachnoid space, venous sinus stenting (VSS) allows us to break this cycle and in many cases effectively relieve the symptoms related to elevated intracranial pressure (ICP). However, IIH symptoms may recur in about 10% of patients.2 In most of these relapsed cases, a stenosis of the stent-adjacent ipsilateral transverse sinus and/or of the proximal third of the superior longitudinal sinus (SLS) is found, which seems to retrigger the pathological loop of IIH. The serial changes in the appearances of the venous system after VSS in asymptomatic or mildly symptomatic patients have never been evaluated in the literature. With our institutional review board approval (IRB: CRM-2001-055), we retrospectively collected the clinical and radiological features of consecutive patients treated with VSS for IIH from January 2013 to December 2019 in our two tertiary-referral institutions. Inclusion criteria were adult patients who underwent VSS for IIH refractory to/with contraindications to medical therapy. All patients underwent a brain 3T-MRI with contrast-enhanced MR venography before and 3–6 months after stent placement. A conventional digital subtracted angiography with venous manometry was performed prior to stent placement under local anaesthesia. The area of the lumen of the dural sinuses, their minimal diameter (online supplemental figures 1 and 2) and their volume (online …