Aims: Idiopathic Intracranial Hypertension (IIH) is a disease primarily affecting young female patients, that may result is permanent visual disturbances and loss of vision in case of delayed diagnosis. For decades, the only treatment of medical therapy resistant IIH was ventriculo-peritoneal shunt implantation. Based on the newest literature data, the stenting of cerebral sinuses using neurointerventional technics may represent a less invasive therapetic alternative to treat IIH. The aim of our study was to prove the safety of these procedures in the Hungarian healthcare system.

Methods: We have analyzed the outcomes of patients who underwent sinus stenting for therapy resistant IIH and bilateral cerebral sinus stenosis between the January of 2022 and March 2024 at the Department of Neurosurgery and Neurointervention of Semmelweis University. All patients were admitted for progressive loss of vision, after ophthalmologic confirmation of papilla edema. MR angiography confirmed bilateral cerebral sinus stenosis, and lumbar puncture confirmed elevated intra-cranial pressure. In case of liquor hypertension, we performed invasive pressure measurements in the cerebral sinuses using a dedicated microcatheter equipped with pressure sensor. When we detected a sinus stenosis with a pressure gradient exceeding 8Hgmm, we performed sinus stenting using a self-expandable, nitinol stents under dual antiplatelet therapy.

Results: In the examined period altogether 11 patients underwent sinus stenting for IIH causing progressive loss of vision due to IIH. Stenting procedure was feasible in all cases, the gradient was eliminated by all procedures and no procedural complication was detected during the surgeries. The vision of all patients improved following the intervention.

Summary and Conclusion: Sinus stenting may represent a minimal invasive therapeutic alternative to VP shuntvimplantation in therapy refractory IIH and bilateral sinus stenosis. While our local short time results of safety and efficacy are convincing, further investigations are needed to prove the long-term efficacy of this treatment modality.