Venous sinus stenting in idiopathic intracranial hypertension: a systematic review of an emerging intervention with favorable outcomes but unresolved standardization.

BACKGROUND: Dural venous sinus stenosis is increasingly implicated in idiopathic intracranial hypertension (IIH), and venous sinus stenting (VSS) has emerged as a therapeutic option. Current evidence is observational and based almost exclusively on off-label stent platforms. METHODS: This PRISMA-compliant systematic review (PROSPERO CRD420261369492) searched MEDLINE, Scopus, and Web of Science from inception through May 2025 for adult studies of VSS in IIH, including all eligible studies published up to that date. Two reviewers independently screened, extracted data, and appraised quality with a modified Newcastle-Ottawa Scale (NOS, 0 to 16). Certainty of evidence for papilledema resolution, headache improvement, and major complications was rated with GRADE. RESULTS: Nineteen studies on 1,210 patients were included: predominantly retrospective single-center cohorts, two case series, two pilot studies, and one multicenter administrative database analysis (Nia 2022), which alone contributed 541 patients through ICD-10 and CPT coding. Mean age ranged 29 to 43 years; women were 67% to 100%. Trans-stenotic pressure gradients fell from 9 to 29 mmHg pre-stenting to near-zero values. Papilledema resolution ranged 36% to 100%, headache improvement 13% to 100%, and major complications 0% to 9.6%. NOS scores ranged 6 to 11 (median 7). Heterogeneity in outcome definitions and ascertainment, including administrative coding in Nia 2022, precluded pooling. GRADE certainty was very low for all three outcomes. CONCLUSIONS: VSS is associated with reliable hemodynamic correction and frequent improvement in papilledema and pulsatile tinnitus; headache response is variable and major complications infrequent. Very low certainty precludes firm recommendations. Standardized outcome definitions and prospective multicenter trials of dedicated venous stents are needed.