Neuroendovascular Dural Venous Sinus Stenting in Idiopathic Intracranial Hypertension : A mini Moroccan Series

Neuroendovascular Dural Venous Sinus Stenting in Idiopathic Intracranial Hypertension : A mini Moroccan Series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Neuroendovascular Dural Venous Sinus Stenting in Idiopathic Intracranial Hypertension : A mini Moroccan Series EL YARMANI Zineb This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9494628/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Transverse Sinus Stenosis is increasingly recognized in Idiopathic Intracranial Hypertension, though its causal role remains controversial. Neuroendovascular dural venous sinus stenting has emerged as a therapeutic option to decrease intracranial pressure and restore cerebrospinal fluid resorption, thus reducing the symptoms. We present a prospective, observational, single-center study from September 2020 to July 2025, to evaluate the safety of this method and its hemodynamic and clinical outcomes. Methods: Consecutive patients with medically refractory, intolerant, or fulminant IIH and confirmed TSS underwent transverse sinus stenting. Pre- and post-procedure data included clinical and ophthalmologic examinations, catheter venography, and ICP measurements. Results: 10 females and 1 male were included with an average age of 29.6 years and a mean BMI of 29.86 kg/m 2 . All had headaches and papilledema, 81.8% reported pulsatile tinnitus, 54.5% nausea/vomiting, 45.5% visual dysfunctions, and 36.3% diplopia. The mean pre-stenting CSF was 45.2 cmH 2 O. Mean trans-stenosis gradient decreased from 11.3 mmHg to 1 mmHg post-stenting. Headache improvement was observed in the majority, with resolution or marked improvement of papilledema and visual symptoms in most cases. Other symptoms have fully resolved. OCT follow-up showed stabilization or improvement of retinal nerve fiber layer thickness in 27.2%. Two patients relapsed within 4 weeks, requiring a Ventriculoperitoneal Shunt. Conclusions: Endovascular VSS offers a safe, effective method to reduce ICP and resolve symptoms. While relapse rates remain a possibility, careful patient selection, optimal stent sizing, and long-term follow-up can help maximize the therapeutic potential. Idiopathic Intracranial Hypertension Central Venous Pressure Interventional Radiology Transverse Sinuses Stenting Figures Figure 1 Figure 2 Figure 3 1. Introduction Idiopathic Intracranial Hypertension (IIH), also known as primary Pseudotumor Cerebri Syndrome (PTCS), is a complex neurological disorder characterized by persistent intracranial pressure (ICP) with no identifiable cause. [ 1 ] It is considered an emergency due to its grievous consequences, such as permanent visual disability or blindness in 30% of the cases from chronic papilledema [ 2 , 3 ], with about 2.4 cases per 100,000 persons in the general population, rising to 22.0 per 100,000 in obese females of childbearing age [ 4 ]. Although the pathophysiology is not fully understood, venous sinus stenosis is observed in approximately 90% of patients [ 5 ] associated with high venous pressures, suggesting that structural alterations in the cerebral sinuses may play a significant role [ 6 , 7 ]. Regardless of the primary or secondary character of the obstruction, the resulting hypertension leads to an additional increase in ICP, culminating in a positive feedback loop [ 7 , 8 ]. Treatment focuses mainly on managing this increase, alleviating headaches, and preserving vision in patients, rather than addressing the underlying pathology. Medical remedies such as weight loss, diuretics, and Acetazolamide [ 9 ], Topiramate, and iterative lumbar punctures have proved efficient against the secondary symptoms [ 10 ]. However, some patients require neuroendovascular intervention or surgery. Indeed, cerebral venous sinus stenting (CVSS) has become a promising therapeutic option [ 8 , 11 ]. By relieving stenosis and restoring cerebrospinal fluid (CSF) resorption in the venous system, stenting can break the feedback loop of elevated ICP, improving symptoms and reducing complications [ 12 – 14 ]. Through our study, we aim to share our experience with CVSS. We strive to evaluate its role in managing IIH patients, focusing on its effect on the trans-stenotic pressure gradient (TSG) and the intensity of symptoms, such as visual function, ophthalmologic testing, headaches, and pulsatile tinnitus. 2. Materials and Methods 2.1. Study design and population In this prospective observational study, we gathered and analyzed the clinical data of eleven patients from September 2020 to July 2025 with an average follow-up of 8 months. They were admitted with symptoms of IIH and referred to our Radiology Department for venous sinus stenting.. 2.1.1. Inclusion Criteria Patients were diagnosed using the Friedman criteria in an awake and alert state after a standardized diagnostic medical interview, neurological and ophthalmological exam, a lumbar puncture to measure the opening pressure (OP), routine blood analysis, and neuroimaging. The criteria included papilledema, normal neurological examination except for the sixth cranial nerve palsy, normal neuroimaging (computed tomography CT or magnetic resonance imaging MRI venographies) with normal brain parenchyma without evidence of hydrocephalus, mass, or structural lesion, and no abnormal meningeal enhancement, normal CSF composition, and an OP higher than 25 cmH 2 O [ 1 ]. Patients were eligible for the stenting if refractory or intolerant to the conservative therapy, had disabling symptoms such as fulminant vision loss, and presented venous sinus stenosis with a significant trans-stenotic gradient (TSG). 2.1.2. Exclusion Criteria Any patient with ineligibility to endovascular procedures, such as coagulopathies, or those with conditions mimicking IIH, such as secondary intracranial hypertension, were excluded. 2.2. Data collection We gathered the clinical summary, including baseline, intraprocedural, and postoperative information from medical charts, paraclinical tests, and neuroimaging results from the hospital database HosixNET and imaging software PACS. The patient’s demographic data included name, gender, current age, time to diagnosis, body mass index (BMI), any relevant medical history related to this pathology, presenting symptoms, and failed therapeutic procedures, whether it be medical, neurosurgical, or endovascular. Informed consent was obtained from all patients. To minimize selection bias, all patients diagnosed with IIH who underwent CVSS at our institution were included consecutively. Information bias was reduced by using standardized data collection forms and confirming imaging and clinical data with at least two independent reviewers. Objective measures, such as lumbar puncture opening pressure and visual field results, were used when possible to reduce subjective interpretation. 2.2.1. Ophthalmic examination After confirming the clinical diagnosis, detailed ophthalmologic examinations were conducted on presentation, before stenting, and during the follow-up. These included funduscopic examinations, visual acuity, and visual field testing to evaluate patients’ eye function. The funduscopic exam focused on identifying optic pathologic changes, most importantly papilledema, which was graded using the Frisén Scale [ 15 ], along with optic disc and retinal edema, atrophy, or hemorrhage, and the quality of macular reflection. Visual fields with automated static threshold perimetry measuring mean deviation (MD) helped detect any field restrictions or scotomas, with mild visual loss defined by an MD between – 2 to – 7 decibels. In some cases, Optical Coherence Tomography (OCT) was performed to measure the retinal nerve fiber layer (RNFL) thickness and determine the extent of the optic nerve defect. 2.2.2. Cerebrospinal Fluid Pressure Lumbar punctures were performed on the presentation to measure the initial CSF opening pressure and rule out any evidence of infection or malignancy by analysing its composition. Many patients underwent iterative punctures to relieve some of their symptoms, though none experienced complete improvement. 2.2.3. Imaging techniques All patients underwent either brain CT or MRV to confirm the diagnosis and obtain detailed images of the dural venous sinuses. In addition, these images focused on finding the indirect signs of elevated ICP, which include the empty sella, flattening of the posterior aspect of the ocular globe, distention of the perioptic subarachnoid space with or without a tortuous optic nerve, or transverse sinus (TS) stenosis [ 16 ]. In cases of bilateral stenosis, the dominant side was chosen for stenting based on flow dynamics and clinical relevance. 2.2.4. Venous sinus stenting procedure Before the stent placement, patients received a standard five to eight-day course of dual antiplatelet therapy consisting of 75 mg of Clopidogrel and 160 mg of Aspirin daily. All stenting procedures were performed under general anesthesia, and intravenous heparin was maintained based on individual body weight. A cerebral angiogram was done at first using a guide catheter through a femoral or radial arterial puncture to visualize the cerebral venous mapping and further observe the morphological features of the stenosis. A guide catheter was then advanced into the internal jugular vein ipsilateral to the stenosis, directed across the stenotic transverse sinus, torcula, and then into the superior sagittal sinus (SSS). A standard pressure was calibrated and connected to record the mean venous pressure in the various sinuses and within the stenotic segment. The trans-stenotic pressure gradient was calculated as the difference in pressure between the distal and proximal stenotic segments. When significant, a stent of appropriate size, in most cases a 7 mm × 50 mm Carotid WALLSTENT, was advanced over the guidewire Rebar AVIGO and deployed across the TS stenosis. This stent is a monorail endoprosthesis and closed-cell, self-expanding. An angiogram was performed once more after releasing the stent to assess the improvement of blood flow in the affected sinus and analyze the changes in hemispheric venous drainage patterns. Post-stent venous manometry was conducted to confirm the effectiveness of the procedure and the elimination of the trans-stenosis pressure gradient. Patients will be on the same dual antiplatelet therapy for 3 months and then, aspirin alone, 100 mg per day, for another 9 months. 2.2.5. Follow-up After the procedure, patients completed questionnaires assessing their initial symptoms and underwent medical, neurological, and ophthalmological examinations. Follow-up imaging, such as cerebral phlebo-CT scan and further tests, was performed to monitor their progress. This approach ensures that changes in symptoms and clinical outcomes are carefully tracked to evaluate the effectiveness of the treatment over time. 3. Results 3.1 Demographic characteristics The eleven patients who underwent the stenting had an average age of 29.6 years (range, 16–43 years), 10 (90.9%) of whom were females. The mean age at diagnosis was 28.2 years (range, 16–43 years). The mean BMI at diagnosis was 29.86 kg/m 2 (range 24-36.1kg/m 2 ). Five (45.4%) had obesity class I, two (18.1%) had obesity class II, two (18.1%) were overweight, and two (18.1%) had a normal weight. [ 17 ]. 36.3% had a recent weight gain close to the episode. 3.2. Medical History Two (18.1%) of our patients were using combined oral contraceptives for years before the symptoms, and two others used an intrauterine device (IUD) contraception. Three (27.2%) of our patients had a history of multiple miscarriages, all of which had negative antiphospholipid and antinuclear antibodies. One (9.09%) patient was known to have Polycystic Ovary Syndrome. One patient had an Idiopathic Retrobulbar Optic Neuritis 5 years before her symptoms, while another one had Vestibular Neuritis in the same year. Another one had cerebral venous thrombosis involving the superior sagittal sinus, transverse sinus, and right jugular vein a year prior, and was under Rivaroxaban. And lastly, another one suffered from migraines since her childhood. None of our patients had a history of intracranial infections, traumatic brain injuries, or any previous neurosurgical or neuro-ophthalmologic intervention. One patient undertook corticosteroids for a year before her first symptoms. Another one suffered from depression and was on Amitriptyline. Five of our patients had microcytic hypochromic anemia. They received iron injections during the procedure. The patient with the fulminant IIH had thrombocytosis. Only one patient had a history of asthma, which was stable. 3.3. Presenting symptoms Our most frequent clinical sign was intense headaches found in 100% of our cases, followed by pulsatile tinnitus in 81.8%, nausea and vomiting in 54.5%, and diplopia and visual dysfunctions in 45.4%, as decreased visual acuity was present in 36.3%, visual blurriness in 27.2%, scotoma and visual eclipses in 18.1%. Notably, one of our patients (P7) experienced severe headaches and acute, rapidly progressive bilateral visual loss within a month, characterized as fulminant IIH. Given the importance of visual impairment, we compiled the ophthalmological changes of the recruited patients. While only four of our cases (36.3%) suffered from decreased visual acuity, all had bilateral papilledema with one (P1) retinal hemorrhage. Five (45.5%) had stage III papilledema, three (27.2%) had stage I-II, and two (18.1%) had stage IV. At the OCT examination, which was only done in five patients, four patients (36.3%) with optic nerve pallor upon arrival, and a reduced thickness of the pRNFL in two. Lastly, at the visual field examination, seven patients (63.6%) out of eleven had moderate to severe visual field deficits and restrictions in multiple areas, especially the nasal and temporal hemifields. Four patients had a general decrease in retinal sensitivity over the majority of the VF. Three patients presented with nearly absolute concentric scotomas covering the entire VF. Lastly, two showed nasal hemianopsia. One patient had a mild visual field loss, which is defined by an MD between − 2 and − 7dB, and two others had a low foveal threshold with severe visual field loss, even lower than − 20dB. Five of our patients had microcytic hypochromic anemia, and the patient with the fulminant IIH had thrombocytosis. A summary of these demographic and clinical data is provided in Table 1 . Table 1 Summary of demographic and clinical data Pt BMI (kg/ m 2 ) Presenting symptoms Visual Acuity Treatment Failure (mg/day) First CSFP / Pre-stenting (cmH 2 O) / N° of LP H P (grade) D N/V Left Right 1 32 IV 10/10 10/10 ACTZ 750 / Topiramate 200 30 / 12 / 4 2 36.1 III 10/10 2/10 ACTZ 1500 53 / 66 / 2 3 25 I-II 10/10 10/10 ACTZ 1500 / Topiramate 100 70 / 31 / 3 4 24 I-II 10/10 10/10 ACTZ 2250 36 / 36 / 1 5 26 III < 10/10 < 10/10 ACTZ 2250 / Topiramate 80 / 80 / 5 6 33 III 0.5/10 3/10 ACTZ 3000 40 / 22 / 3 7 35 III 3/10 5/10 ACTZ 2250 90 / 50 / 3 8 30 I-II 10/10 10/10 ACTZ 1500 40 / 40 / 1 9 33 IV 10/10 10/10 ACTZ 3000 64 / 26 / 2 10 24.4 – 10/10 10/10 ACTZ 1500 96 / 97 / 2 11 30 III 10/10 10/10 ACTZ 1500 / Topiramate 34 / 38 / 2 3.4. Imaging data All 11 patients presented at least one indirect sign of IIH at the CT-scan or MRI. 100% of them had dilated and tortuous optic nerve sheaths, seven patients (63.6%) had arachnoidocele, and three (27.2%) of them had flattening of the posterior aspect of the ocular globe. All of our patients had bilateral transverse sinus stenosis. The dominant stenosis was in the right transverse sinus for 8 patients (72.7%) and in the left one in the remaining 3 (27.2%). All of the stenoses were extrinsic. Representative imaging examples of these indirect signs in our patients are shown in Fig. 1 . 3.5. Opening CSF pressure In our study, the mean initial cerebrospinal fluid opening pressure was 57.5 cmH 2 O (range: 30–96 cmH 2 O) with normal cerebrospinal composition in all patients. On average, patients underwent 2.5 lumbar punctures (range, 5 − 1) before stenting. The mean pre-stenting CSF pressure was 45.2 cmH 2 O (range, 12–97 cmH 2 O). 3.6. Failed treatments Alongside losing weight, Acetazolamide was the main treatment used in our study. It was often used alone at maximum tolerated doses (100%), which differed from one patient to another. No side effects were noted under this treatment, except for one patient who experienced some paresthesia. In some cases, we associated it with Topiramate (36.3%). None of our patients underwent a surgical intervention before the stenting. 3.7. Stenting procedure 3.7.1. Stent placement Ten of our patients required only one stenting procedure. The remaining one needed a second procedure due to post-thrombotic sequelae and unfavorable anatomy of the sigmoid sinus, which required a more suitable micro-catheter to catheterize the sigmoid portion. None of them called for repeated stent placement. No patients had peri- or postprocedural complications from stenting, such as intracranial hemorrhage. The stented sinus was the right one in 72.7% of cases and the left one in 27.2%. 3.7.2. Venous pressures Before the procedure, the mean venous pressure of the SSS, the torcula, and the pre-stenotic and post-stenotic segment was, respectively, in mmHg: 30.6 (range: 72 − 12), 29.6 (range: 66 − 12), 29.5 (range: 66 − 12), and 18.1 (range: 34 − 5). After the procedure, these pressures decreased to, respectively, in mmHg: 19.89 (range: 44 − 11), 19.11 (range: 42 − 10), 18.78 (range: 42 − 7), and 17.3 (range: 36 − 4). The mean venous pressure trans-stenosis gradient fell from 11.3 mmHg (range: 32 − 4) before stenting to 1 mmHg (range: 6 − 0). An overview of the stenting procedures, pressure measurements, and clinical outcomes is provided in Table 2 . Table 2 Summary regarding cerebral venous sinus stenting and outcome Pt Transverse Sinus Stented TS Gradient (mmHg) Sinus Venometry (mmHg) Before / After Visual Acuity Before After SSS T Pre-Stenotic Post-Stenotic Left Right 1 Left 32 6 72 / 44 66 / 42 66 / 42 34 / 36 10/10 10/10 2 Right 10 0 32 / 12 35 / 11 32 / 11 22 / 11 10/10 2/10 3 Right 17 3 26 / 11 23 / 10 22 / 7 5 / 4 10/10 10/10 4 Right 6 0 28 / 24 28 / 24 27 / 24 22 / 24 10/10 10/10 5 Right 8 0 34 / 27 33 / 27 34 / 27 26 / 26 9/10 9/10 6 Left 8 0 24 / – 24 / – 23 / – 15 / – 4/10 4/10 7 Right 9 1 29 / 11 28 / 10 28 / 10 19 / 9 –/10 –/10 8 Right 19 1 33 / 22 32 / 21 36 / 21 17 / 20 10/10 10/10 9 Right 4 0 16 / 13 15 / 12 15 / 12 13 / 11 10/10 10/10 10 Right 4 0 12 / 15 12 / 15 12 / 15 8 / 15 10/10 10/10 11 Left 8 0 –/– –/– –/– –/– –/– –/– 3.8. Follow-up data In the long-term follow-up evaluations post-stenting, 54.5% of our patients reported complete headache relief throughout the follow-up period; some only felt an improvement (27.2%) or a relapse (18.1%). Four (80%) of the five patients with diplopia reported a complete resolution, while the remaining one (20%) noticed an improvement. The improvement started within 24 hours of the procedure in most patients. Visual disturbances improved in most patients, as the visual blur, the scotoma, and the visual eclipses all resolved. One patient who had decreased visual acuity improved significantly from 0.5/10 in the left eye and 3/10 in the right eye to 5/10 in both eyes. The remaining three didn’t show any significant improvement. The other symptoms, such as tinnitus, nausea, and vomiting, resolved completely. All 20 eyes with papilledema showed an improvement in Frisen grade of at least 1 grade, with some having a complete resolution (54.5%). These changes appeared as early as the first month post-stenting. The retinal hemorrhage didn’t experience any change. Four of our patients improved their visual field in comparison with the previous one, mostly in the peripheral field, especially the temporal. Two patients had stability in the visual field. The foveal threshold of one patient improved from 31dB to 38dB. The nasal hemianopsia, the decrease in retinal sensitivity, the visual field loss, and the scotomas didn’t show any improvement. OCT follow-up showed a slight improvement in macular and RNFL thickness in one, an overall improvement in another two, while one showed further optic fiber alteration and mild impairment. The overall follow-up imaging showed the metallic stent in place with a permeable sinus, and good opacification of the dural venous sinuses. In three of our patients (P1, P2, P3), a focal stenosis of the contralateral lateral sinus was shown in the imaging despite adequate stenting of the treated sinus. These findings were stable over the follow-up period and did not have any symptomatic repercussions. Three patients (P3, P7, P8) showed a significant reduction in optic nerve sheath enlargement and resolution of tortuosity of the optic nerves over the follow-up time. P7 showed significant regression of intracranial hypertension signs at the 3-month imaging, while P4 and P6 still showed sellar arachnoidocele, tortuous optic nerves, and ONS enlargement, suggesting partial improvement only. It is important to note that persistent imaging signs were not correlated with clinical symptoms. In all patients, Acetazolamide was continued immediately after the stenting procedure to maintain intracranial pressure control, in contrast to Topiramate, which was discontinued. A progressive tapering protocol was adopted, personalized to each patient based on their clinical evolution, paraclinical examinations, and tolerability. At the end of the follow-up, 36.3% of patients completely stopped Acetazolamide, while 36.3% got from 3000mg/day to as low as 750mg/day. 3.9. Relapse and complications No major complications were noted. Four patients experienced transient post-operative headaches that were managed conservatively. No cases of stent migration, vessel perforation, in-stent thrombosis, obstructive hydrocephalus, or subdural and intracerebral hemorrhage occurred. Two (18.1%) patients in our study relapsed after showing initial improvement within the first 4 weeks following the stenting. The first patient (P1) suffered from refractory high-intensity headaches and deterioration of visual acuity. Their imaging revealed peri-stent restenosis with a CSF pressure of 20 cmH 2 O at the lumbar puncture. Notably, a smaller stent (7 mm × 30 mm Wall stent) had been used instead of the standard 7 mm × 50 mm Wall stent. The decision was to subsequently perform a Ventriculoperitoneal Shunt, which resulted in good clinical improvement. The second case (P4) showed a recurrence of their clinical symptoms and worsening of the visual field with a CSF pressure of 35 cmH 2 O four months after their initial stenting and a CT scan showing indirect signs of IIH (arachnoidocele and flattening of the posterior aspect of the ocular globe). The decision was to refer the patient for a Ventriculoperitoneal Shunt placement. 4. Discussion This prospective observational series provides further evidence supporting the safety and effectiveness of CVSS in managing IIH patients refractory, intolerant to maximal medical treatments, or with fulminant cases. The novel findings of this study, consistent with the current research, demonstrate immediate and sustained resolution of the TSG, relief of symptoms, and preservation of visual examinations, all of which lead to better patient outcomes [ 18 – 20 ]. 4.1. Pathophysiological considerations The pathogenesis of IIH remains poorly understood to this day; however, two main mechanisms are widely discussed: impaired CSF absorption and venous outflow obstruction. The CSF absorption is a pressure-dependent process that relies on the gradient between the subarachnoid space and the dural venous sinuses, and its physiology is closely related to the ICP. The primary theory suggests that if there is an intrinsic granulation dysfunction or elevated venous pressure, this gradient is reduced or even reversed, which leads to further transverse sinus collapse, impaired CSF resorption, and further elevation of ICP. Although the arachnoid granulations represent the primary pathway for CSF absorption in adults, alternative routes contribute as well, including glymphatic or cerebral lymphatic drainage. Uni or bilateral venous sinus stenosis seems prevalent among most IIH patients (90%) and can be an important contributor to the disease’s progression [ 6 , 7 , 21 ]. Venous pressures even proved to be higher in IIH patients than in controls, which led to a growing recognition that these structural alterations play a significant role [ 5 , 7 ]. These stenoses can be extrinsic, resulting from smooth, long-segment narrowing likely secondary to intracranial hypertension, or intrinsic, due to arachnoid granulations or fibrous septae. However, the different characteristics of the stenosis do not seem to impact the intensity of the symptoms or clinical outcome [ 19 , 22 , 23 ]. This interplay between venous sinus stenosis, elevated venous pressures, reduced CSF absorption, and glymphatic dysfunction suggests that IIH is not solely a disorder of CSF absorption at arachnoid villi but rather a global disturbance of CSF-interstitial fluid dynamics involving both macroscopic venous drainage and microscopic perivascular transport. The different proposed mechanisms of raised ICP in the current literature are summarized in Fig. 3 . 4.2. Symptom resolution and visual outcomes Initially described by Higgins et al. [ 24 ], this technique has emerged as a pivotal advancement in improving the signs and symptoms of IIH patients with lower complications and a better quality of life, all observed in our cohort. Notably, 81.8% of our patients reported headache resolution or significant improvement during follow-up, a finding supported by a recent meta-analysis showing a resolution in 79% of patients [ 25 ]. Another major finding was the reduction in the trans-stenotic gradient (from 11.3 mmHg to 1 mmHg), consistent with reports from Teleb et al. and Dinkin et al. This hemodynamic correction mirrors the marked symptomatic and ophthalmological improvement we documented. Ophthalmic improvements were also notable: most patients demonstrated papilledema regression and visual function recovery, which is critical given the risk of irreversible optic neuropathy in IIH [ 26 ]. The mechanism is mostly explained by the significant and sustained reductions in ICP through restored venous outflow, breaking the feedback loop. Similarly, pulsatile tinnitus is typically caused by turbulent blood flow through stenosed venous sinuses, which means stenting restores laminar blood flow and reduces the turbulence responsible for the pulsatile sound. This physiological change explains the complete resolution of tinnitus in our patients post-procedure, corroborating similar findings in the literature [ 27 ]. One patient underwent stenting because of fulminant IIH with bilateral papilledema stage III, rapidly progressive decreased visual acuity, and severely depressed visual fields, all within two weeks, with no apparent improvement with the conservative treatments at maximum doses. After the procedure, she experienced a phenomenal improvement in her symptoms, and most importantly, no vision loss occurred. This positive outcome aligns with the report indicating that, even without CSF diversion procedures, venous stenting can still offer normalization of ICP, effectively reducing the risk of permanent severe vision loss in fulminant cases of IIH [ 28 ]. 4.3. Technical considerations and procedural strategy Although all of our patients exhibited bilateral stenosis, the stenting was only performed on the dominant sinus. Regardless of that, the venous hypertension still normalized, and the symptoms still resolved. This suggests, as noticed in other studies, that the restoration of a single, competent transverse sinus prevents the development of IIH [ 29 ]. Two patients (18.1%) in this series experienced relapses, highlighting potential complications of the procedure. One patient developed peri-stent restenosis due to the use of an inadequate-sized stent. Although uncommon, some studies have reported similar cases [ 29 ], underlining the importance of a longer stent selection to provide better coverage of the stenotic segment. None of our patients suffered from stenting complications such as stent migration, in-stent thrombosis, and, most concerningly, intracranial hemorrhage. These justify long-term monitoring of stent patency and individualized post-operative care. A comparative summary of previously published studies evaluating CVSS for IIH, including sample sizes, outcomes, and complications, is presented in Table 3 . Table 3 Characteristics of IIH patients treated by CVSS in the literature Author N° of Patients/ Female Median Age (years) BMI Presenting Symptoms Mean CSF OP Mean gradie nt Symptoms Improvement 2nd proce dure H P PT H P PT Higgins et al. 2003 12/12 33 36.9 12 8 NR 33.7 19 7 5 NR 2 Donnet et al. 2008 10/8 42 28.7 10 10 5 40 19 8 10 5 1 Ahmed et al. 2011 52/47 34 > 30 43 45 17 32 19 35 45 17 6 Kumpe et al. 2012–2016 39/28 36 34 31 37 NR 40 23 23 33 NR 8 Teleb et al. 2015 18/15 30 36 18 18 5 NR 14 10 18 4 6 Liu et al. 2017 10/9 34 42 10 7 5 43 30 9 7 NR 2 Satti et al. 2017 43/39 35 35 43 22 NR 36 17 27 13 NR 2 Martinez-Gutierrez et al. 2022 53/37 32 36 53 46 50 35 10 49 40 45 NR Ahmed et al. 2024 1056/910 33 34.3 840 834 543 37.1 18.5 664 742 516 NR Our study 2025 11/10 29.6 29.8 11 11 9 45.2 11.3 9 11 9 2 Totals/ Average 1304/1115 33.8 34.3 1071 1038 634 38 18 841 924 596 29 4.4. Comparison with alternative interventions Traditionally, refractory patients are first referred for CSF shunting or optic nerve sheath fenestration (ONSF) [ 30 ]. However, CVSS has shown superior effectiveness in improving symptoms, managing IIH progression, and lowering ICP [ 9 , 25 ], especially in severe or fulminant disease. Over the last two decades, more studies have focused on comparing the outcomes related to those interventions, proving the higher success rate of CVSS over both ONSF and CSF diversion procedures regarding symptom resolution, durability of outcomes, and complication profiles [ 25 , 30 ]. Stenting not only alleviates symptoms but also targets outflow obstruction, which is a potential underlying pathology. It serves as an intermediate option between conservative therapy and more invasive surgeries, offering a less invasive alternative with shorter recovery times. 4.5. Study limitations The main limitation of our work is the small cohort size, explained by the relative rarity of patients meeting strict selection criteria. This restricts the generalizability of our findings to the IIH population. Furthermore, the absence of standardized long-term follow-up metrics in all patients, particularly in visual field testing and OCT measurements, may have resulted in underestimating subtle improvements or deteriorations in visual function. 4.6. Future directions Our results support transverse sinus stenting as a safe and potentially effective option for selected patients with confirmed venous outflow resistance. It is an effective intermediate intervention between conservative therapy and more invasive neurosurgical procedures. Future multicenter studies with larger cohorts and standardized ophthalmologic and hemodynamic endpoints are needed to refine patient selection, optimize device choice and sizing, and define long-term outcomes. 5. Conclusion CVSS is a promising treatment for selected patients who are refractory to conservative therapies and present a significant trans-stenotic gradient. This procedure relieves symptoms and targets the underlying venous pathology, breaking the pathological cycle of elevated ICP. While complications and relapse rates remain possible, careful patient selection, optimal stent sizing, and long-term follow-up can maximize the procedure's therapeutic potential. Abbreviations IIH = Idiopathic Intracranial Hypertension; ICP = intracranial pressure; PTCS = Pseudotumor Cerebri Syndrome; CVSS = cerebral venous sinus stenting; TSG = trans-stenotic pressure gradient; OP = opening pressure; CT = computed tomography; MRI = magnetic resonance imaging; BMI = body mass index; OCT = Optical Coherence Tomography; RNFL = retinal nerve fiber layer; SAT = supra-aortic trunks; MRV = Magnetic Resonance Venography; TS = transverse sinus; SSS = superior sagittal sinus; ONSF = optic nerve sheath fenestration; H = headaches; P = papilledema; D = diplopia; N/V = nausea/vomiting; ACTZ = acetazolamide; LP = lumbar punctures. Declarations 6. Declaration of funding The authors received no financial support for the research, authorship, and/or publication of this article. 7. Declaration of ethics This research was conducted following ethical guidelines and principles. The study received ethical approval from the research ethics board. All patient information was de-identified, and patient consent was not required. Patient data will not be shared with third parties. References Friedman DI, Liu GT, Digre KB (2013) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 81:1159–1165. https://doi.org/10.1212/WNL.0b013e3182a55f17 Best J, Silvestri G, Burton B, Foot B, Acheson J (2013) The Incidence of Blindness Due to Idiopathic Intracranial Hypertension in the UK. Open Ophthalmol J 7:26–29. https://doi.org/10.2174/1874364101307010026 Endovascular stenting for idiopathic intracranial hypertension with venous sinus stenosis (2024) - PMC n.d. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520302/#brb31279-sec–0006title Kilgore KP, Lee MS, Leavitt JA, Mokri B, Hodge DO, Frank RD et al (2017) Re-Evaluating the Incidence of Idiopathic Intracranial Hypertension in an Era of Increasing Obesity. Ophthalmology 124:697. https://doi.org/10.1016/j.ophtha.2017.01.006 Esfahani DR, Stevenson M, Moss HE, Amin-Hanjani S, Aletich V, Jain S et al (2015) Quantitative MRV is Correlated with Intravenous Pressures Before and After Venous Sinus Stenting: Implications for Treatment and Monitoring. Neurosurgery 77:254. https://doi.org/10.1227/NEU.0000000000000771 Riggeal BD, Bruce BB, Saindane AM, Ridha MA, Kelly LP, Newman NJ et al (2013) Clinical course of idiopathic intracranial hypertension with transverse sinus stenosis. Neurology 80:289–295. https://doi.org/10.1212/WNL.0b013e31827debd6 Dinkin M, Oliveira C (2019) Men Are from Mars, Idiopathic Intracranial Hypertension Is from Venous: The Role of Venous Sinus Stenosis and Stenting in Idiopathic Intracranial Hypertension. Semin Neurol 39:692–703. https://doi.org/10.1055/s–0039 Daggubati LC, Liu KC Intracranial Venous Sinus Stenting: A Review of Idiopathic Intracranial Hypertension and Expanding Indications. Cureus n d ;11:e4008. https://doi.org/10.7759/cureus.4008 Effect of Acetazolamide on Visual Function in Patients With Idiopathic Intracranial Hypertension and Mild Visual Loss (2014) JAMA 311:1641–1651. https://doi.org/10.1001/jama.2014.3312 Mollan SP, Davies B, Silver NC, Shaw S, Mallucci CL, Wakerley BR et al (2018) Idiopathic intracranial hypertension: consensus guidelines on management. J Neurol Neurosurg Psychiatry 89:1088–1100. https://doi.org/10.1136/jnnp–2017–317440 Spitze A, Malik A, Lee AG (2014) Surgical and endovascular interventions in idiopathic intracranial hypertension. Curr Opin Neurol 27:69–74. https://doi.org/10.1097/WCO.0000000000000049 Toshniwal SS, Kinkar J, Chadha Y, Khurana K, Reddy H, Kadam A et al Navigating the Enigma: A Comprehensive Review of Idiopathic Intracranial Hypertension. Cureus n d ;16:e56256. https://doi.org/10.7759/cureus.56256 Fargen KM, Coffman S, Torosian T, Brinjikji W, Nye BL, Hui F (2023) Idiopathic intracranial hypertension: An update from neurointerventional research for clinicians. Cephalalgia 43:03331024231161323. https://doi.org/10.1177/03331024231161323 Kulhari A, He M, Fourcand F, Singh A, Zacharatos H, Mehta S et al (2020) Safety and Clinical Outcomes after Transverse Venous Sinus Stenting for Treatment of Refractory Idiopathic Intracranial Hypertension: Single Center Experience. J Vasc Interv Neurol 11:6–12 Frisen grades (2017) https://www.aao.org/education/image/frisen-grades (accessed October 10, 2024) Barkatullah AF, Leishangthem L, Moss HE (2021) MRI findings as markers of idiopathic intracranial hypertension. Curr Opin Neurol 34:75–83. https://doi.org/10.1097/WCO.0000000000000885 Weir CB, Jan A (2024) BMI Classification Percentile And Cut Off Points. StatPearls, Treasure Island (FL): StatPearls Publishing; Liu KC, Starke RM, Durst CR, Wang TR, Ding D, Crowley RW et al (2017) Venous sinus stenting for reduction of intracranial pressure in IIH: a prospective pilot study. J Neurosurg 127:1126–1133. https://doi.org/10.3171/2016.8.JNS16879 Dinkin MJ, Patsalides A (2017) Venous Sinus Stenting in Idiopathic Intracranial Hypertension: Results of a Prospective Trial. J Neuroophthalmol 37:113–121. https://doi.org/10.1097/WNO.0000000000000426 Silva JMA, Conti MLM, Aguiar GB, Jory M, Monzillo PH, Veiga JCE (2017) Endovascular Treatment for Idiopathic Intracranial Hypertension Improves Clinical Symptoms and Signs. Arq Bras Neurocir Braz Neurosurg 36:01–6. https://doi.org/10.1055/s–0036 Farb RI, Vanek I, Scott JN, Mikulis DJ, Willinsky RA, Tomlinson G et al (2003) Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 60:1418–1424. https://doi.org/10.1212/01.wnl.0000066683.34093.e2 Raynald, Huo X, Yang H, Wang Z, Tong X, Li X et al (2021) Characteristics and Outcomes of the Idiopathic Intracranial Hypertension Treatment in Intrinsic and Extrinsic Stenosis: A Single-Center Experience in China. Neurol Ther 10:1029–1044. https://doi.org/10.1007/s40120-021-00281–0 Lenck S, Vallée F, Labeyrie M-A, Touitou V, Saint-Maurice J-P, Guillonnet A et al (2017) Stenting of the Lateral Sinus in Idiopathic Intracranial Hypertension According to the Type of Stenosis. Neurosurgery 80:393. https://doi.org/10.1227/NEU.0000000000001261 Higgins JNP, Cousins C, Owler BK, Sarkies N, Pickard JD (2003) Idiopathic intracranial hypertension: 12 Cases treated by venous sinus stenting. J Neurol Neurosurg Psychiatry 74:1662–1666. https://doi.org/10.1136/jnnp.74.12.1662 Azzam AY, Mortezaei A, Morsy MM, Essibayi MA, Ghozy S, Elamin O et al (2024) Venous sinus stenting for idiopathic intracranial hypertension: An updated Meta-analysis. J Neurol Sci 459:122948. https://doi.org/10.1016/j.jns.2024.122948 Bussière M, Falero R, Nicolle D, Proulx A, Patel V, Pelz D (2010) Unilateral Transverse Sinus Stenting of Patients with Idiopathic Intracranial Hypertension. Am J Neuroradiol 31:645–650. https://doi.org/10.3174/ajnr.A1890 Dinkin MJ, Patsalides A (2023) Idiopathic Intracranial Venous Hypertension: Toward a Better Understanding of Venous Stenosis and the Role of Stenting in Idiopathic Intracranial Hypertension. J Neuro-Ophthalmol Off J North Am Neuro-Ophthalmol Soc 43:451–463. https://doi.org/10.1097/WNO.0000000000001898 Elder BD, Goodwin CR, Kosztowski TA, Radvany MG, Gailloud P, Moghekar A et al (2015) Venous sinus stenting is a valuable treatment for fulminant idiopathic intracranial hypertension. J Clin Neurosci Off J Neurosurg Soc Australas 22:685–689. https://doi.org/10.1016/j.jocn.2014.10.012 Ahmed RM, Wilkinson M, Parker GD, Thurtell MJ, Macdonald J, McCluskey PJ et al (2011) Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions. AJNR Am J Neuroradiol 32:1408–1414. https://doi.org/10.3174/ajnr.A2575 Satti SR, Leishangthem L, Chaudry MI (2015) Meta-Analysis of CSF Diversion Procedures and Dural Venous Sinus Stenting in the Setting of Medically Refractory Idiopathic Intracranial Hypertension. Am J Neuroradiol 36:1899–1904. https://doi.org/10.3174/ajnr.A4377 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9494628","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":627657065,"identity":"b9f37d35-f77a-4c64-b5f9-f3b8ced866ce","order_by":0,"name":"EL YARMANI Zineb","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABJklEQVRIiWNgGAWjYDACZjBikIFyJeSABBtRWnhgWowJa2FA1cKQ2EBIi3w778HHBQw2PAbHzz7d8HOHRfqG86fTHvxgsJNnEDv8AJsWxma+ZOMZDGk8BmfSzW72npHI3XAjd7thD0OyYYN0mgFWRzHzmEnzMBzmMTiQxnaDtw2khXebBA8DcwKDdAJWLWzMPOa/eRj+8xicf8Z282+bRLrB+bPbJP8w1AO1pH/ApoUHaAszD8MBHoMbaWy3gbYkGBzI3QayF6glB6stEsw8xtIzDJJ5JG88Y7st2yZhOBPoF2MZg+OGbdI5BVhDrP+M4eeCCjs5vvNpbDffttXJ8wEd9vBNRbU8v3T6BmxaIADoAIUD6CIEI1S+gZCKUTAKRsEoGLEAAFIOVb0Dm2DfAAAAAElFTkSuQmCC","orcid":"","institution":"CENTRE HOSPITALIER UNIVERSITAIRE HASSAN II","correspondingAuthor":true,"prefix":"","firstName":"EL","middleName":"YARMANI","lastName":"Zineb","suffix":""}],"badges":[],"createdAt":"2026-04-22 10:12:03","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9494628/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9494628/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107620451,"identity":"5b25a177-4a62-4520-b5f9-49fea97e7535","added_by":"auto","created_at":"2026-04-23 09:37:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2012157,"visible":true,"origin":"","legend":"\u003cp\u003eIndirect signs of IIH. \u003cbr\u003e\nA : flattening of the posterior aspect of the ocular globe, \u003cbr\u003e\ndistention of the perioptic subarachnoid space with a tortuous optic nerve. \u003cbr\u003e\nB : empty sella.\u003cbr\u003e\nC,D,E : bilateral stenosis of the mid-portion of the transverse sinuses.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9494628/v1/a752d2f1ac67f74b9253b154.png"},{"id":107707571,"identity":"fb47638a-449d-4ffa-814a-54c1f7908e03","added_by":"auto","created_at":"2026-04-24 09:20:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1890518,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePre- and post-stenting cerebral angiography. \u003c/strong\u003eLateral (\u003cstrong\u003eA\u003c/strong\u003e) and Antero-posterior (\u003cstrong\u003eB\u003c/strong\u003e) pre-operative venogram images showing the transverse sinus stenosis and the manometry at different measurement points using a pressure sensor. \u003cstrong\u003eC: \u003c/strong\u003eAngiographic control showing the restoration of a good luminal caliber of the right transverse sinus, with no venous stasis of the contrast agent. \u003cstrong\u003eD: \u003c/strong\u003eManometry after stenting showing complete regression of the pressure gradient.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9494628/v1/729d4754599445d532b61a38.png"},{"id":107707259,"identity":"e81b6762-7ef3-4754-9223-c94b2e5f1edc","added_by":"auto","created_at":"2026-04-24 09:19:55","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1884437,"visible":true,"origin":"","legend":"\u003cp\u003eCurrent proposed mechanisms of raised intracranial pressure in the literature\u003c/p\u003e","description":"","filename":"Fig52.png","url":"https://assets-eu.researchsquare.com/files/rs-9494628/v1/834f0a821d3bbb1774bafba3.png"},{"id":107709381,"identity":"d43af474-2483-421c-90e1-745afc31a412","added_by":"auto","created_at":"2026-04-24 09:35:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6381655,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9494628/v1/d464136d-c079-419d-bfe9-72271355120b.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eNeuroendovascular Dural Venous Sinus Stenting in Idiopathic Intracranial Hypertension : A mini Moroccan Series\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eIdiopathic Intracranial Hypertension (IIH), also known as primary Pseudotumor Cerebri Syndrome (PTCS), is a complex neurological disorder characterized by persistent intracranial pressure (ICP) with no identifiable cause. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] It is considered an emergency due to its grievous consequences, such as permanent visual disability or blindness in 30% of the cases from chronic papilledema [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], with about 2.4 cases per 100,000 persons in the general population, rising to 22.0 per 100,000 in obese females of childbearing age [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Although the pathophysiology is not fully understood, venous sinus stenosis is observed in approximately 90% of patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] associated with high venous pressures, suggesting that structural alterations in the cerebral sinuses may play a significant role [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Regardless of the primary or secondary character of the obstruction, the resulting hypertension leads to an additional increase in ICP, culminating in a positive feedback loop [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Treatment focuses mainly on managing this increase, alleviating headaches, and preserving vision in patients, rather than addressing the underlying pathology. Medical remedies such as weight loss, diuretics, and Acetazolamide [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], Topiramate, and iterative lumbar punctures have proved efficient against the secondary symptoms [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, some patients require neuroendovascular intervention or surgery. Indeed, cerebral venous sinus stenting (CVSS) has become a promising therapeutic option [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. By relieving stenosis and restoring cerebrospinal fluid (CSF) resorption in the venous system, stenting can break the feedback loop of elevated ICP, improving symptoms and reducing complications [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThrough our study, we aim to share our experience with CVSS. We strive to evaluate its role in managing IIH patients, focusing on its effect on the trans-stenotic pressure gradient (TSG) and the intensity of symptoms, such as visual function, ophthalmologic testing, headaches, and pulsatile tinnitus.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study design and population\u003c/h2\u003e \u003cp\u003eIn this prospective observational study, we gathered and analyzed the clinical data of eleven patients from September 2020 to July 2025 with an average follow-up of 8 months. They were admitted with symptoms of IIH and referred to our Radiology Department for venous sinus stenting..\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003e2.1.1. Inclusion Criteria\u003c/h2\u003e \u003cp\u003ePatients were diagnosed using the Friedman criteria in an awake and alert state after a standardized diagnostic medical interview, neurological and ophthalmological exam, a lumbar puncture to measure the opening pressure (OP), routine blood analysis, and neuroimaging. The criteria included papilledema, normal neurological examination except for the sixth cranial nerve palsy, normal neuroimaging (computed tomography CT or magnetic resonance imaging MRI venographies) with normal brain parenchyma without evidence of hydrocephalus, mass, or structural lesion, and no abnormal meningeal enhancement, normal CSF composition, and an OP higher than 25 cmH\u003csub\u003e2\u003c/sub\u003eO [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients were eligible for the stenting if refractory or intolerant to the conservative therapy, had disabling symptoms such as fulminant vision loss, and presented venous sinus stenosis with a significant trans-stenotic gradient (TSG).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.1.2. Exclusion Criteria\u003c/h2\u003e \u003cp\u003eAny patient with ineligibility to endovascular procedures, such as coagulopathies, or those with conditions mimicking IIH, such as secondary intracranial hypertension, were excluded.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Data collection\u003c/h2\u003e \u003cp\u003eWe gathered the clinical summary, including baseline, intraprocedural, and postoperative information from medical charts, paraclinical tests, and neuroimaging results from the hospital database HosixNET and imaging software PACS. The patient\u0026rsquo;s demographic data included name, gender, current age, time to diagnosis, body mass index (BMI), any relevant medical history related to this pathology, presenting symptoms, and failed therapeutic procedures, whether it be medical, neurosurgical, or endovascular. Informed consent was obtained from all patients.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTo minimize selection bias, all patients diagnosed with IIH who underwent CVSS at our institution were included consecutively. Information bias was reduced by using standardized data collection forms and confirming imaging and clinical data with at least two independent reviewers. Objective measures, such as lumbar puncture opening pressure and visual field results, were used when possible to reduce subjective interpretation.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.2.1. Ophthalmic examination\u003c/h2\u003e \u003cp\u003eAfter confirming the clinical diagnosis, detailed ophthalmologic examinations were conducted on presentation, before stenting, and during the follow-up. These included funduscopic examinations, visual acuity, and visual field testing to evaluate patients\u0026rsquo; eye function. The funduscopic exam focused on identifying optic pathologic changes, most importantly papilledema, which was graded using the Fris\u0026eacute;n Scale [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], along with optic disc and retinal edema, atrophy, or hemorrhage, and the quality of macular reflection. Visual fields with automated static threshold perimetry measuring mean deviation (MD) helped detect any field restrictions or scotomas, with mild visual loss defined by an MD between \u0026ndash; 2 to \u0026ndash; 7 decibels. In some cases, Optical Coherence Tomography (OCT) was performed to measure the retinal nerve fiber layer (RNFL) thickness and determine the extent of the optic nerve defect.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.2.2. Cerebrospinal Fluid Pressure\u003c/h2\u003e \u003cp\u003eLumbar punctures were performed on the presentation to measure the initial CSF opening pressure and rule out any evidence of infection or malignancy by analysing its composition. Many patients underwent iterative punctures to relieve some of their symptoms, though none experienced complete improvement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.2.3. Imaging techniques\u003c/h2\u003e \u003cp\u003eAll patients underwent either brain CT or MRV to confirm the diagnosis and obtain detailed images of the dural venous sinuses. In addition, these images focused on finding the indirect signs of elevated ICP, which include the empty sella, flattening of the posterior aspect of the ocular globe, distention of the perioptic subarachnoid space with or without a tortuous optic nerve, or transverse sinus (TS) stenosis [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn cases of bilateral stenosis, the dominant side was chosen for stenting based on flow dynamics and clinical relevance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.2.4. Venous sinus stenting procedure\u003c/h2\u003e \u003cp\u003eBefore the stent placement, patients received a standard five to eight-day course of dual antiplatelet therapy consisting of 75 mg of Clopidogrel and 160 mg of Aspirin daily.\u003c/p\u003e \u003cp\u003eAll stenting procedures were performed under general anesthesia, and intravenous heparin was maintained based on individual body weight. A cerebral angiogram was done at first using a guide catheter through a femoral or radial arterial puncture to visualize the cerebral venous mapping and further observe the morphological features of the stenosis.\u003c/p\u003e \u003cp\u003eA guide catheter was then advanced into the internal jugular vein ipsilateral to the stenosis, directed across the stenotic transverse sinus, torcula, and then into the superior sagittal sinus (SSS). A standard pressure was calibrated and connected to record the mean venous pressure in the various sinuses and within the stenotic segment. The trans-stenotic pressure gradient was calculated as the difference in pressure between the distal and proximal stenotic segments. When significant, a stent of appropriate size, in most cases a 7 mm \u0026times; 50 mm Carotid WALLSTENT, was advanced over the guidewire Rebar AVIGO and deployed across the TS stenosis. This stent is a monorail endoprosthesis and closed-cell, self-expanding. An angiogram was performed once more after releasing the stent to assess the improvement of blood flow in the affected sinus and analyze the changes in hemispheric venous drainage patterns. Post-stent venous manometry was conducted to confirm the effectiveness of the procedure and the elimination of the trans-stenosis pressure gradient.\u003c/p\u003e \u003cp\u003ePatients will be on the same dual antiplatelet therapy for 3 months and then, aspirin alone, 100 mg per day, for another 9 months.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.2.5. Follow-up\u003c/h2\u003e \u003cp\u003eAfter the procedure, patients completed questionnaires assessing their initial symptoms and underwent medical, neurological, and ophthalmological examinations. Follow-up imaging, such as cerebral phlebo-CT scan and further tests, was performed to monitor their progress. This approach ensures that changes in symptoms and clinical outcomes are carefully tracked to evaluate the effectiveness of the treatment over time.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003e3.1 Demographic characteristics\u003c/h2\u003e\n\u003cp\u003eThe eleven patients who underwent the stenting had an average age of 29.6 years (range, 16\u0026ndash;43 years), 10 (90.9%) of whom were females. The mean age at diagnosis was 28.2 years (range, 16\u0026ndash;43 years).\u003c/p\u003e\n\u003cp\u003eThe mean BMI at diagnosis was 29.86 kg/m\u003csup\u003e2\u003c/sup\u003e (range 24-36.1kg/m\u003csup\u003e2\u003c/sup\u003e). Five (45.4%) had obesity class I, two (18.1%) had obesity class II, two (18.1%) were overweight, and two (18.1%) had a normal weight. [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003e36.3% had a recent weight gain close to the episode.\u003c/h3\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n\u003ch2\u003e3.2. Medical History\u003c/h2\u003e\n\u003cp\u003eTwo (18.1%) of our patients were using combined oral contraceptives for years before the symptoms, and two others used an intrauterine device (IUD) contraception. Three (27.2%) of our patients had a history of multiple miscarriages, all of which had negative antiphospholipid and antinuclear antibodies. One (9.09%) patient was known to have Polycystic Ovary Syndrome.\u003c/p\u003e\n\u003cp\u003eOne patient had an Idiopathic Retrobulbar Optic Neuritis 5 years before her symptoms, while another one had Vestibular Neuritis in the same year. Another one had cerebral venous thrombosis involving the superior sagittal sinus, transverse sinus, and right jugular vein a year prior, and was under Rivaroxaban. And lastly, another one suffered from migraines since her childhood.\u003c/p\u003e\n\u003cp\u003eNone of our patients had a history of intracranial infections, traumatic brain injuries, or any previous neurosurgical or neuro-ophthalmologic intervention.\u003c/p\u003e\n\u003cp\u003eOne patient undertook corticosteroids for a year before her first symptoms. Another one suffered from depression and was on Amitriptyline.\u003c/p\u003e\n\u003cp\u003eFive of our patients had microcytic hypochromic anemia. They received iron injections during the procedure. The patient with the fulminant IIH had thrombocytosis.\u003c/p\u003e\n\u003cp\u003eOnly one patient had a history of asthma, which was stable.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n\u003ch2\u003e3.3. Presenting symptoms\u003c/h2\u003e\n\u003cp\u003eOur most frequent clinical sign was intense headaches found in 100% of our cases, followed by pulsatile tinnitus in 81.8%, nausea and vomiting in 54.5%, and diplopia and visual dysfunctions in 45.4%, as decreased visual acuity was present in 36.3%, visual blurriness in 27.2%, scotoma and visual eclipses in 18.1%.\u003c/p\u003e\n\u003cp\u003eNotably, one of our patients (P7) experienced severe headaches and acute, rapidly progressive bilateral visual loss within a month, characterized as fulminant IIH.\u003c/p\u003e\n\u003cp\u003eGiven the importance of visual impairment, we compiled the ophthalmological changes of the recruited patients. While only four of our cases (36.3%) suffered from decreased visual acuity, all had bilateral papilledema with one (P1) retinal hemorrhage. Five (45.5%) had stage III papilledema, three (27.2%) had stage I-II, and two (18.1%) had stage IV. At the OCT examination, which was only done in five patients, four patients (36.3%) with optic nerve pallor upon arrival, and a reduced thickness of the pRNFL in two.\u003c/p\u003e\n\u003cp\u003eLastly, at the visual field examination, seven patients (63.6%) out of eleven had moderate to severe visual field deficits and restrictions in multiple areas, especially the nasal and temporal hemifields. Four patients had a general decrease in retinal sensitivity over the majority of the VF. Three patients presented with nearly absolute concentric scotomas covering the entire VF. Lastly, two showed nasal hemianopsia.\u003c/p\u003e\n\u003cp\u003eOne patient had a mild visual field loss, which is defined by an MD between \u0026minus;\u0026thinsp;2 and \u0026minus;\u0026thinsp;7dB, and two others had a low foveal threshold with severe visual field loss, even lower than \u0026minus;\u0026thinsp;20dB.\u003c/p\u003e\n\u003cp\u003eFive of our patients had microcytic hypochromic anemia, and the patient with the fulminant IIH had thrombocytosis.\u003c/p\u003e\n\u003cp\u003eA summary of these demographic and clinical data is provided in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSummary of demographic and clinical data\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePt\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003cp\u003e(kg/\u003c/p\u003e\n\u003cp\u003em\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003ePresenting symptoms\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVisual Acuity\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTreatment\u003c/p\u003e\n\u003cp\u003eFailure (mg/day)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eFirst CSFP /\u003c/p\u003e\n\u003cp\u003ePre-stenting (cmH\u003csub\u003e2\u003c/sub\u003eO) /\u003c/p\u003e\n\u003cp\u003eN\u0026deg; of LP\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eH\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP (grade)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN/V\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLeft\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 750 / Topiramate 200\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 / 12 / 4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 1500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53 / 66 / 2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eI-II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 1500 / Topiramate 100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e70 / 31 / 3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eI-II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 2250\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36 / 36 / 1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 2250 / Topiramate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80 / 80 / 5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.5/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 3000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40 / 22 / 3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 2250\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e90 / 50 / 3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eI-II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 1500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40 / 40 / 1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 3000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64 / 26 / 2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 1500\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e96 / 97 / 2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eACTZ 1500 / Topiramate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 / 38 / 2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n\u003ch2\u003e3.4. Imaging data\u003c/h2\u003e\n\u003cp\u003eAll 11 patients presented at least one indirect sign of IIH at the CT-scan or MRI.\u003c/p\u003e\n\u003cp\u003e100% of them had dilated and tortuous optic nerve sheaths, seven patients (63.6%) had arachnoidocele, and three (27.2%) of them had flattening of the posterior aspect of the ocular globe.\u003c/p\u003e\n\u003cp\u003eAll of our patients had bilateral transverse sinus stenosis. The dominant stenosis was in the right transverse sinus for 8 patients (72.7%) and in the left one in the remaining 3 (27.2%). All of the stenoses were extrinsic.\u003c/p\u003e\n\u003cp\u003eRepresentative imaging examples of these indirect signs in our patients are shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n\u003ch2\u003e3.5. Opening CSF pressure\u003c/h2\u003e\n\u003cp\u003eIn our study, the mean initial cerebrospinal fluid opening pressure was 57.5 cmH\u003csub\u003e2\u003c/sub\u003eO (range: 30\u0026ndash;96 cmH\u003csub\u003e2\u003c/sub\u003eO) with normal cerebrospinal composition in all patients.\u003c/p\u003e\n\u003cp\u003eOn average, patients underwent 2.5 lumbar punctures (range, 5\u0026thinsp;\u0026minus;\u0026thinsp;1) before stenting.\u003c/p\u003e\n\u003cp\u003eThe mean pre-stenting CSF pressure was 45.2 cmH\u003csub\u003e2\u003c/sub\u003eO (range, 12\u0026ndash;97 cmH\u003csub\u003e2\u003c/sub\u003eO).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n\u003ch2\u003e3.6. Failed treatments\u003c/h2\u003e\n\u003cp\u003eAlongside losing weight, Acetazolamide was the main treatment used in our study. It was often used alone at maximum tolerated doses (100%), which differed from one patient to another. No side effects were noted under this treatment, except for one patient who experienced some paresthesia. In some cases, we associated it with Topiramate (36.3%).\u003c/p\u003e\n\u003cp\u003eNone of our patients underwent a surgical intervention before the stenting.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n\u003ch2\u003e3.7. Stenting procedure\u003c/h2\u003e\n\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\n\u003ch2\u003e3.7.1. Stent placement\u003c/h2\u003e\n\u003cp\u003eTen of our patients required only one stenting procedure. The remaining one needed a second procedure due to post-thrombotic sequelae and unfavorable anatomy of the sigmoid sinus, which required a more suitable micro-catheter to catheterize the sigmoid portion.\u003c/p\u003e\n\u003cp\u003eNone of them called for repeated stent placement. No patients had peri- or postprocedural complications from stenting, such as intracranial hemorrhage.\u003c/p\u003e\n\u003cp\u003eThe stented sinus was the right one in 72.7% of cases and the left one in 27.2%.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section3\"\u003e\n\u003ch2\u003e3.7.2. Venous pressures\u003c/h2\u003e\n\u003cp\u003eBefore the procedure, the mean venous pressure of the SSS, the torcula, and the pre-stenotic and post-stenotic segment was, respectively, in mmHg: 30.6 (range: 72\u0026thinsp;\u0026minus;\u0026thinsp;12), 29.6 (range: 66\u0026thinsp;\u0026minus;\u0026thinsp;12), 29.5 (range: 66\u0026thinsp;\u0026minus;\u0026thinsp;12), and 18.1 (range: 34\u0026thinsp;\u0026minus;\u0026thinsp;5).\u003c/p\u003e\n\u003cp\u003eAfter the procedure, these pressures decreased to, respectively, in mmHg: 19.89 (range: 44\u0026thinsp;\u0026minus;\u0026thinsp;11), 19.11 (range: 42\u0026thinsp;\u0026minus;\u0026thinsp;10), 18.78 (range: 42\u0026thinsp;\u0026minus;\u0026thinsp;7), and 17.3 (range: 36\u0026thinsp;\u0026minus;\u0026thinsp;4).\u003c/p\u003e\n\u003cp\u003eThe mean venous pressure trans-stenosis gradient fell from 11.3 mmHg (range: 32\u0026thinsp;\u0026minus;\u0026thinsp;4) before stenting to 1 mmHg (range: 6\u0026thinsp;\u0026minus;\u0026thinsp;0).\u003c/p\u003e\n\u003cp\u003eAn overview of the stenting procedures, pressure measurements, and clinical outcomes is provided in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSummary regarding cerebral venous sinus stenting and outcome\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePt\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTransverse Sinus Stented\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTS Gradient (mmHg)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eSinus Venometry (mmHg)\u003c/p\u003e\n\u003cp\u003eBefore / After\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVisual Acuity\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBefore\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAfter\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSSS\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eT\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePre-Stenotic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePost-Stenotic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eLeft\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLeft\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72 / 44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66 / 42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e66 / 42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 / 36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32 / 12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 / 11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32 / 11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 / 11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2/10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 / 11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 / 10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 / 7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 / 4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 / 24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 / 24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27 / 24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 / 24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 / 27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33 / 27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 / 27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 / 26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9/10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLeft\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 / \u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 / \u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 / \u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15 / \u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4/10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 / 11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 / 10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 / 10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 / 9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;/10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33 / 22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32 / 21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36 / 21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17 / 20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 / 13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15 / 12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15 / 12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 / 11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRight\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 / 15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 / 15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 / 15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 / 15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/10\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLeft\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;/\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;/\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;/\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;/\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;/\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ndash;/\u0026ndash;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\n\u003ch2\u003e3.8. Follow-up data\u003c/h2\u003e\n\u003cp\u003eIn the long-term follow-up evaluations post-stenting, 54.5% of our patients reported complete headache relief throughout the follow-up period; some only felt an improvement (27.2%) or a relapse (18.1%). Four (80%) of the five patients with diplopia reported a complete resolution, while the remaining one (20%) noticed an improvement. The improvement started within 24 hours of the procedure in most patients.\u003c/p\u003e\n\u003cp\u003eVisual disturbances improved in most patients, as the visual blur, the scotoma, and the visual eclipses all resolved. One patient who had decreased visual acuity improved significantly from 0.5/10 in the left eye and 3/10 in the right eye to 5/10 in both eyes. The remaining three didn\u0026rsquo;t show any significant improvement.\u003c/p\u003e\n\u003cp\u003eThe other symptoms, such as tinnitus, nausea, and vomiting, resolved completely.\u003c/p\u003e\n\u003cp\u003eAll 20 eyes with papilledema showed an improvement in Frisen grade of at least 1 grade, with some having a complete resolution (54.5%). These changes appeared as early as the first month post-stenting. The retinal hemorrhage didn\u0026rsquo;t experience any change.\u003c/p\u003e\n\u003cp\u003eFour of our patients improved their visual field in comparison with the previous one, mostly in the peripheral field, especially the temporal. Two patients had stability in the visual field. The foveal threshold of one patient improved from 31dB to 38dB. The nasal hemianopsia, the decrease in retinal sensitivity, the visual field loss, and the scotomas didn\u0026rsquo;t show any improvement.\u003c/p\u003e\n\u003cp\u003eOCT follow-up showed a slight improvement in macular and RNFL thickness in one, an overall improvement in another two, while one showed further optic fiber alteration and mild impairment.\u003c/p\u003e\n\u003cp\u003eThe overall follow-up imaging showed the metallic stent in place with a permeable sinus, and good opacification of the dural venous sinuses. In three of our patients (P1, P2, P3), a focal stenosis of the contralateral lateral sinus was shown in the imaging despite adequate stenting of the treated sinus. These findings were stable over the follow-up period and did not have any symptomatic repercussions. Three patients (P3, P7, P8) showed a significant reduction in optic nerve sheath enlargement and resolution of tortuosity of the optic nerves over the follow-up time. P7 showed significant regression of intracranial hypertension signs at the 3-month imaging, while P4 and P6 still showed sellar arachnoidocele, tortuous optic nerves, and ONS enlargement, suggesting partial improvement only. It is important to note that persistent imaging signs were not correlated with clinical symptoms.\u003c/p\u003e\n\u003cp\u003eIn all patients, Acetazolamide was continued immediately after the stenting procedure to maintain intracranial pressure control, in contrast to Topiramate, which was discontinued. A progressive tapering protocol was adopted, personalized to each patient based on their clinical evolution, paraclinical examinations, and tolerability. At the end of the follow-up, 36.3% of patients completely stopped Acetazolamide, while 36.3% got from 3000mg/day to as low as 750mg/day.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\n\u003ch2\u003e3.9. Relapse and complications\u003c/h2\u003e\n\u003cp\u003eNo major complications were noted. Four patients experienced transient post-operative headaches that were managed conservatively. No cases of stent migration, vessel perforation, in-stent thrombosis, obstructive hydrocephalus, or subdural and intracerebral hemorrhage occurred.\u003c/p\u003e\n\u003cp\u003eTwo (18.1%) patients in our study relapsed after showing initial improvement within the first 4 weeks following the stenting.\u003c/p\u003e\n\u003cp\u003eThe first patient (P1) suffered from refractory high-intensity headaches and deterioration of visual acuity. Their imaging revealed peri-stent restenosis with a CSF pressure of 20 cmH\u003csub\u003e2\u003c/sub\u003eO at the lumbar puncture. Notably, a smaller stent (7 mm \u0026times; 30 mm Wall stent) had been used instead of the standard 7 mm \u0026times; 50 mm Wall stent. The decision was to subsequently perform a Ventriculoperitoneal Shunt, which resulted in good clinical improvement.\u003c/p\u003e\n\u003cp\u003eThe second case (P4) showed a recurrence of their clinical symptoms and worsening of the visual field with a CSF pressure of 35 cmH\u003csub\u003e2\u003c/sub\u003eO four months after their initial stenting and a CT scan showing indirect signs of IIH (arachnoidocele and flattening of the posterior aspect of the ocular globe). The decision was to refer the patient for a Ventriculoperitoneal Shunt placement.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis prospective observational series provides further evidence supporting the safety and effectiveness of CVSS in managing IIH patients refractory, intolerant to maximal medical treatments, or with fulminant cases. The novel findings of this study, consistent with the current research, demonstrate immediate and sustained resolution of the TSG, relief of symptoms, and preservation of visual examinations, all of which lead to better patient outcomes [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Pathophysiological considerations\u003c/h2\u003e \u003cp\u003eThe pathogenesis of IIH remains poorly understood to this day; however, two main mechanisms are widely discussed: impaired CSF absorption and venous outflow obstruction. The CSF absorption is a pressure-dependent process that relies on the gradient between the subarachnoid space and the dural venous sinuses, and its physiology is closely related to the ICP. The primary theory suggests that if there is an intrinsic granulation dysfunction or elevated venous pressure, this gradient is reduced or even reversed, which leads to further transverse sinus collapse, impaired CSF resorption, and further elevation of ICP. Although the arachnoid granulations represent the primary pathway for CSF absorption in adults, alternative routes contribute as well, including glymphatic or cerebral lymphatic drainage.\u003c/p\u003e \u003cp\u003eUni or bilateral venous sinus stenosis seems prevalent among most IIH patients (90%) and can be an important contributor to the disease\u0026rsquo;s progression [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Venous pressures even proved to be higher in IIH patients than in controls, which led to a growing recognition that these structural alterations play a significant role [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These stenoses can be extrinsic, resulting from smooth, long-segment narrowing likely secondary to intracranial hypertension, or intrinsic, due to arachnoid granulations or fibrous septae. However, the different characteristics of the stenosis do not seem to impact the intensity of the symptoms or clinical outcome [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis interplay between venous sinus stenosis, elevated venous pressures, reduced CSF absorption, and glymphatic dysfunction suggests that IIH is not solely a disorder of CSF absorption at arachnoid villi but rather a global disturbance of CSF-interstitial fluid dynamics involving both macroscopic venous drainage and microscopic perivascular transport.\u003c/p\u003e \u003cp\u003eThe different proposed mechanisms of raised ICP in the current literature are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Symptom resolution and visual outcomes\u003c/h2\u003e \u003cp\u003eInitially described by Higgins et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], this technique has emerged as a pivotal advancement in improving the signs and symptoms of IIH patients with lower complications and a better quality of life, all observed in our cohort. Notably, 81.8% of our patients reported headache resolution or significant improvement during follow-up, a finding supported by a recent meta-analysis showing a resolution in 79% of patients [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Another major finding was the reduction in the trans-stenotic gradient (from 11.3 mmHg to 1 mmHg), consistent with reports from Teleb et al. and Dinkin et al. This hemodynamic correction mirrors the marked symptomatic and ophthalmological improvement we documented.\u003c/p\u003e \u003cp\u003eOphthalmic improvements were also notable: most patients demonstrated papilledema regression and visual function recovery, which is critical given the risk of irreversible optic neuropathy in IIH [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The mechanism is mostly explained by the significant and sustained reductions in ICP through restored venous outflow, breaking the feedback loop. Similarly, pulsatile tinnitus is typically caused by turbulent blood flow through stenosed venous sinuses, which means stenting restores laminar blood flow and reduces the turbulence responsible for the pulsatile sound. This physiological change explains the complete resolution of tinnitus in our patients post-procedure, corroborating similar findings in the literature [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne patient underwent stenting because of fulminant IIH with bilateral papilledema stage III, rapidly progressive decreased visual acuity, and severely depressed visual fields, all within two weeks, with no apparent improvement with the conservative treatments at maximum doses. After the procedure, she experienced a phenomenal improvement in her symptoms, and most importantly, no vision loss occurred. This positive outcome aligns with the report indicating that, even without CSF diversion procedures, venous stenting can still offer normalization of ICP, effectively reducing the risk of permanent severe vision loss in fulminant cases of IIH [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Technical considerations and procedural strategy\u003c/h2\u003e \u003cp\u003eAlthough all of our patients exhibited bilateral stenosis, the stenting was only performed on the dominant sinus. Regardless of that, the venous hypertension still normalized, and the symptoms still resolved. This suggests, as noticed in other studies, that the restoration of a single, competent transverse sinus prevents the development of IIH [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwo patients (18.1%) in this series experienced relapses, highlighting potential complications of the procedure. One patient developed peri-stent restenosis due to the use of an inadequate-sized stent. Although uncommon, some studies have reported similar cases [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], underlining the importance of a longer stent selection to provide better coverage of the stenotic segment. None of our patients suffered from stenting complications such as stent migration, in-stent thrombosis, and, most concerningly, intracranial hemorrhage. These justify long-term monitoring of stent patency and individualized post-operative care.\u003c/p\u003e \u003cp\u003eA comparative summary of previously published studies evaluating CVSS for IIH, including sample sizes, outcomes, and complications, is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of IIH patients treated by CVSS in the literature\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eN\u0026deg; of Patients/ Female\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMedian Age (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003ePresenting\u003c/p\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003cp\u003eCSF\u003c/p\u003e \u003cp\u003eOP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003cp\u003egradie\u003c/p\u003e \u003cp\u003ent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003cp\u003eImprovement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2nd\u003c/p\u003e \u003cp\u003eproce\u003c/p\u003e \u003cp\u003edure\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eH\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003ePT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHiggins et al. 2003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12/12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDonnet et al. 2008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10/8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAhmed et al. 2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52/47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKumpe et al. 2012\u0026ndash;2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39/28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeleb et al. 2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18/15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiu et al. 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10/9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatti et al. 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43/39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMartinez-Gutierrez et al. 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53/37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAhmed et al. 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1056/910\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e37.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eNR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOur study 2025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotals/ Average\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1304/1115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e924\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e4.4. Comparison with alternative interventions\u003c/h2\u003e \u003cp\u003eTraditionally, refractory patients are first referred for CSF shunting or optic nerve sheath fenestration (ONSF) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, CVSS has shown superior effectiveness in improving symptoms, managing IIH progression, and lowering ICP [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], especially in severe or fulminant disease. Over the last two decades, more studies have focused on comparing the outcomes related to those interventions, proving the higher success rate of CVSS over both ONSF and CSF diversion procedures regarding symptom resolution, durability of outcomes, and complication profiles [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Stenting not only alleviates symptoms but also targets outflow obstruction, which is a potential underlying pathology. It serves as an intermediate option between conservative therapy and more invasive surgeries, offering a less invasive alternative with shorter recovery times.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec30\" class=\"Section2\"\u003e \u003ch2\u003e4.5. Study limitations\u003c/h2\u003e \u003cp\u003eThe main limitation of our work is the small cohort size, explained by the relative rarity of patients meeting strict selection criteria. This restricts the generalizability of our findings to the IIH population. Furthermore, the absence of standardized long-term follow-up metrics in all patients, particularly in visual field testing and OCT measurements, may have resulted in underestimating subtle improvements or deteriorations in visual function.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003e4.6. Future directions\u003c/h2\u003e \u003cp\u003eOur results support transverse sinus stenting as a safe and potentially effective option for selected patients with confirmed venous outflow resistance. It is an effective intermediate intervention between conservative therapy and more invasive neurosurgical procedures. Future multicenter studies with larger cohorts and standardized ophthalmologic and hemodynamic endpoints are needed to refine patient selection, optimize device choice and sizing, and define long-term outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eCVSS is a promising treatment for selected patients who are refractory to conservative therapies and present a significant trans-stenotic gradient. This procedure relieves symptoms and targets the underlying venous pathology, breaking the pathological cycle of elevated ICP. While complications and relapse rates remain possible, careful patient selection, optimal stent sizing, and long-term follow-up can maximize the procedure's therapeutic potential.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIIH\u0026thinsp;=\u0026thinsp;Idiopathic Intracranial Hypertension; ICP\u0026thinsp;=\u0026thinsp;intracranial pressure; PTCS\u0026thinsp;=\u0026thinsp;Pseudotumor Cerebri Syndrome; CVSS\u0026thinsp;=\u0026thinsp;cerebral venous sinus stenting; TSG\u0026thinsp;=\u0026thinsp;trans-stenotic pressure gradient; OP\u0026thinsp;=\u0026thinsp;opening pressure; CT\u0026thinsp;=\u0026thinsp;computed tomography; MRI\u0026thinsp;=\u0026thinsp;magnetic resonance imaging; BMI\u0026thinsp;=\u0026thinsp;body mass index; OCT\u0026thinsp;=\u0026thinsp;Optical Coherence Tomography; RNFL\u0026thinsp;=\u0026thinsp;retinal nerve fiber layer; SAT\u0026thinsp;=\u0026thinsp;supra-aortic trunks; MRV\u0026thinsp;=\u0026thinsp;Magnetic Resonance Venography; TS\u0026thinsp;=\u0026thinsp;transverse sinus; SSS\u0026thinsp;=\u0026thinsp;superior sagittal sinus; ONSF\u0026thinsp;=\u0026thinsp;optic nerve sheath fenestration; H\u0026thinsp;=\u0026thinsp;headaches; P\u0026thinsp;=\u0026thinsp;papilledema; D\u0026thinsp;=\u0026thinsp;diplopia; N/V\u0026thinsp;=\u0026thinsp;nausea/vomiting; ACTZ\u0026thinsp;=\u0026thinsp;acetazolamide; LP\u0026thinsp;=\u0026thinsp;lumbar punctures.\u003c/p\u003e"},{"header":"Declarations","content":"\n\u003ch3\u003e6. Declaration of funding\u003c/h3\u003e\n \u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003ch3\u003e7. Declaration of ethics\u003c/h3\u003e\n\u003cp\u003e This research was conducted following ethical guidelines and principles. The study received ethical approval from the research ethics board. All patient information was de-identified, and patient consent was not required. Patient data will not be shared with third parties.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFriedman DI, Liu GT, Digre KB (2013) Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. 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AJNR Am J Neuroradiol 32:1408\u0026ndash;1414. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3174/ajnr.A2575\u003c/span\u003e\u003cspan address=\"10.3174/ajnr.A2575\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSatti SR, Leishangthem L, Chaudry MI (2015) Meta-Analysis of CSF Diversion Procedures and Dural Venous Sinus Stenting in the Setting of Medically Refractory Idiopathic Intracranial Hypertension. Am J Neuroradiol 36:1899\u0026ndash;1904. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3174/ajnr.A4377\u003c/span\u003e\u003cspan address=\"10.3174/ajnr.A4377\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Centre Hospitalier Universitaire Hassan II","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Idiopathic Intracranial Hypertension, Central Venous Pressure, Interventional Radiology, Transverse Sinuses, Stenting","lastPublishedDoi":"10.21203/rs.3.rs-9494628/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9494628/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eTransverse Sinus Stenosis is increasingly recognized in Idiopathic Intracranial Hypertension, though its causal role remains controversial. Neuroendovascular dural venous sinus stenting has emerged as a therapeutic option to decrease intracranial pressure and restore cerebrospinal fluid resorption, thus reducing the symptoms. We present a prospective, observational, single-center study from September 2020 to July 2025, to evaluate the safety of this method and its hemodynamic and clinical outcomes.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eConsecutive patients with medically refractory, intolerant, or fulminant IIH and confirmed TSS underwent transverse sinus stenting. Pre- and post-procedure data included clinical and ophthalmologic examinations, catheter venography, and ICP measurements.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003e10 females and 1 male were included with an average age of 29.6 years and a mean BMI of 29.86 kg/m\u003csup\u003e2\u003c/sup\u003e. All had headaches and papilledema, 81.8% reported pulsatile tinnitus, 54.5% nausea/vomiting, 45.5% visual dysfunctions, and 36.3% diplopia. The mean pre-stenting CSF was 45.2 cmH\u003csub\u003e2\u003c/sub\u003eO. Mean trans-stenosis gradient decreased from 11.3 mmHg to 1 mmHg post-stenting. Headache improvement was observed in the majority, with resolution or marked improvement of papilledema and visual symptoms in most cases. Other symptoms have fully resolved. OCT follow-up showed stabilization or improvement of retinal nerve fiber layer thickness in 27.2%. Two patients relapsed within 4 weeks, requiring a Ventriculoperitoneal Shunt.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eEndovascular VSS offers a safe, effective method to reduce ICP and resolve symptoms. While relapse rates remain a possibility, careful patient selection, optimal stent sizing, and long-term follow-up can help maximize the therapeutic potential.\u003c/p\u003e","manuscriptTitle":"Neuroendovascular Dural Venous Sinus Stenting in Idiopathic Intracranial Hypertension : A mini Moroccan Series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 09:37:36","doi":"10.21203/rs.3.rs-9494628/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b554094a-1571-4221-a91b-1c2fd7647bac","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-23T09:37:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 09:37:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9494628","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9494628","identity":"rs-9494628","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}