Efficacy of transverse sinus stenting in fulminant idiopathic intracranial hypertension in patients with high grade papilledema grade 3 and 4

Back ground: Idiopathic intracranial hypertension (IIH) is an increase in intracranial pressure without intracranial mass or any known etiology. The major morbidity with IIH is visual loss due to secondary papilledema.Aim of the study: The aim is to evaluate the efficacy of transverse sinus stenting in patients with fulminant IIH due to transverse sinus stenosis (TSS) with high grade papilledema III and IV.Methodology: It is pre followed by post intervention; prospective study was done on 70 patients diagnosed with fulminant IIH due to TSS with high grade papilledema III and IV over 2 years. Diagnostic and therapeutic angiogram with stenting was done at AL-Nasr hospital - one of comprehensive health insurance hospitals in port-said city - and the military hospital.Results: The study evaluates 70 patients; the majority were female (88.6%) with a mean age of 37.88 years and a mean BMI of 33.5 kg/m². Before stenting, most patients had severe headaches (76.7%), blurred vision (56.7%), and tinnitus (100%). After stenting, (50%) had no headaches, (88.3%) had no blurred vision, and tinnitus totally resolved. Before stenting, most patients had grade III (88.7%) or grade IV (11.3%) papilledema. After stenting, (53%) had no papilledema. Stenting reduced mean CSF pressure from 45.82 cmH2O to 19.94 cmH2O and median venous pressure gradient from 10 mmHg to 2 mmHg. Two patients experienced re-stenosis and required re-stenting.Conclusion: Transverse sinus stenting is a safe and effective procedure in treating patients with fulminant IIH due to TSS with high grade papilledema III and IV.