Dr. Athos Patsalides and Dr. Marc Dinkin have published the results of a successful clinical trial testing the effectiveness of venous sinus stenting for some patients with idiopathic intracranial hypertension (IIH, also known as pseudotumor cerebri). The results, which show improvement or complete resolution of symptoms in nearly all patients, also hold promise for patients with pulsatile tinnitus.
The stenting technique was tested in patients with IIH whose imaging tests also showed a narrowing (stenosis) in one or more of the large veins in the brain. In patients with venous sinus stenosis, using a stent to widen the vein significantly reduced or resolved the headaches, vision problems, tinnitus, and other IIH symptoms the patients had experienced.
In the trial, 13 patients with IIH who had not responded to medical therapy or who could not tolerate the side effects of drug treatment, or who had significant vision problems, were treated with a stent. Placement of the stent is a minimally invasive procedure that starts with a small incision in the leg; the stent is threaded up to the narrowed vein and then expanded to widen the vessel, relieving the intracranial pressure.
All 13 of the patients treated reported improvement or even complete resolution of their pulsatile tinnitus and their vision problems; 11 reported improvement or resolution of their headaches. On quantitative measures of papilledema (swelling of the optic nerve) and retinal nerve fiber layer (RNFL) thickness, improvements were measured at 80 to 90 percent. No serious adverse events were reported.
Dr. Patsalides and Dr. Dinkin published their results in the June 2017 issue of the Journal of Neuro-Ophthalmology, concluding that venous sinus stenting is safe and effective in patients with IIH. They are now conducting a new clinical trial testing their stenting procedure in patients with pulsatile tinnitus only (without IIH), and early results are promising. (See “I Am So Grateful for the Silence,” a patient’s story about having the VSS procedure for tinnitus.)
