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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleNeurointervention
Open Access

Evolution of MRI Findings in Patients with Idiopathic Intracranial Hypertension after Venous Sinus Stenting

N.F. Belachew, W. Almiri, R. Encinas, A. Hakim, S. Baschung, J. Kaesmacher, T. Dobrocky, C.J. Schankin, M. Abegg, E.I. Piechowiak, A. Raabe, J. Gralla and P. Mordasini
American Journal of Neuroradiology November 2021, 42 (11) 1993-2000; DOI: https://doi.org/10.3174/ajnr.A7311
N.F. Belachew
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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W. Almiri
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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R. Encinas
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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A. Hakim
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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S. Baschung
fFaculty of Medicine (S.B.), University of Bern, Bern, Switzerland
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J. Kaesmacher
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
bDepartment of Diagnostic, Interventional and Pediatric Radiology (J.K.)
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T. Dobrocky
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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C.J. Schankin
cDepartment of Neurology (C.J.S.)
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M. Abegg
dDepartment of Ophthalmology (M.A.)
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E.I. Piechowiak
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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A. Raabe
eDepartment of Neurosurgery (A.R.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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J. Gralla
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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P. Mordasini
aFrom the Department of Diagnostic and Interventional Neuroradiology (N.F.B., W.A., R.E., A.H., J.K., T.D., E.I.P., J.G., P.M.)
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Abstract

BACKGROUND AND PURPOSE: The correlation between imaging findings and clinical status in patients with idiopathic intracranial hypertension is unclear. We aimed to examine the evolution of idiopathic intracranial hypertension–related MR imaging findings in patients treated with venous sinus stent placement.

MATERIALS AND METHODS: Thirteen patients with idiopathic intracranial hypertension (median age, 26.9 years) were assessed for changes in the CSF opening pressure, transstenotic pressure gradient, and symptoms after venous sinus stent placement. Optic nerve sheath diameter, posterior globe flattening and/or optic nerve protrusion, empty sella, the Meckel cave, tonsillar ectopia, the ventricles, the occipital emissary vein, and subcutaneous fat were evaluated on MR imaging before and 6 months after venous sinus stent placement. Data are expressed as percentages, medians, or correlation coefficients (r) with P values.

RESULTS: Although all patients showed significant reductions of the CSF opening pressure (31 versus 21 cm H2O; P = .005) and transstenotic pressure gradient (22.5 versus 1.5 mm Hg; P = .002) and substantial improvement of clinical symptoms 6 months after venous sinus stent placement, a concomitant reduction was observed only for posterior globe involvement (61.5% versus 15.4%; P = .001), optic nerve sheath diameter (6.8  versus 6.1 mm; P < .001), and subcutaneous neck fat (8.9  versus 7.4 mm; P = .001). Strong correlations were observed between decreasing optic nerve sheath diameters and improving nausea/emesis (right optic nerve sheath diameter, r =  0.592, P = .033; left optic nerve sheath diameter, r = 0.718, P = .006), improvement of posterior globe involvement and decreasing papilledema (r = 0.775, P = .003), and decreasing occipital emissary vein diameter and decreasing headache frequency (r = 0.74, P = .035). Decreasing transstenotic pressure gradient at 6 months strongly correlated with decreasing empty sella (r = 0.625, P = .022) and regressing cerebellar ectopia (r = 0.662, P = .019).

CONCLUSIONS: Most imaging findings persist long after normalization of intracranial pressure and clinical improvement. However, MR imaging findings related to the optic nerve may reflect treatment success.

ABBREVIATIONS:

IIH
idiopathic intracranial hypertension
VAS
visual analog scale
  • © 2021 by American Journal of Neuroradiology

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N.F. Belachew, W. Almiri, R. Encinas, A. Hakim, S. Baschung, J. Kaesmacher, T. Dobrocky, C.J. Schankin, M. Abegg, E.I. Piechowiak, A. Raabe, J. Gralla, P. Mordasini
Evolution of MRI Findings in Patients with Idiopathic Intracranial Hypertension after Venous Sinus Stenting
American Journal of Neuroradiology Nov 2021, 42 (11) 1993-2000; DOI: 10.3174/ajnr.A7311

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Evolution of MRI Findings in Patients with Idiopathic Intracranial Hypertension after Venous Sinus Stenting
N.F. Belachew, W. Almiri, R. Encinas, A. Hakim, S. Baschung, J. Kaesmacher, T. Dobrocky, C.J. Schankin, M. Abegg, E.I. Piechowiak, A. Raabe, J. Gralla, P. Mordasini
American Journal of Neuroradiology Nov 2021, 42 (11) 1993-2000; DOI: 10.3174/ajnr.A7311
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