Venous Sinus Stent versus Ventriculoperitoneal Shunt: Comparing clinical outcomes for Idiopathic Intracranial Hypertension (IIH)

Sunday, May 5, 2024

4:29 PM – 4:31 PM CT

Location: S405a

Presenting Author(s)

Austin M. Hilvert, B.S. (he/him/his)

Medical Student
Vanderbilt University Medical Center
Nashville, TN, US

Co-Author(s)

RC

Rohan Chitale, MD

Associate Professor of Neurological Surgery
Vanderbilt University Medical Center, United States
MF

Michael Froehler, MD, PhD

Associate Professor of Neurology
Vanderbilt University Medical Center, United States
MF

Matthew R. Fusco, MD

Assistant Professor of Neurological Surgery and Radiology & Radiological Sciences
Vanderbilt University Medical Center, United States
Fatima Gauhar, MBBS (she/her/hers)

Research Fellow
Vanderbilt University Medical Center
Nashville, TN, US
HG

Heather C. Grimaudo, MD

Resident
Vanderbilt University Medical Center, United States
ML

Michael Longo, MD

Resident
Vanderbilt University Medical Center, United States
NM

Nishit Mummareddy, MD

Resident
Vanderbilt University Medical Center, United States

Disclosure(s):

Austin M. Hilvert, B.S.: No financial relationships to disclose

Introduction: Venous sinus stenting (VSS) has been shown to reduce venous pressures and improve symptoms in patients with idiopathic intracranial hypertension (IIH). However, longer term follow-up data is limited and concern exists that longitudinal symptom improvement may subside with VSS as compared to ventriculoperitoneal shunting (VPS). We aimed to compare symptom improvement and outcomes between the two treatment modalities.

Methods: A retrospective case-control study was designed to assess 87 patients with IIH that met inclusion criteria and underwent either VSS (n=27) or VPS (n=60) at a single medical center between 2017 and 2022. Descriptive statistics for baseline characteristics and outcomes were calculated followed by multivariate logistic regression modeling to identify factors associated with headache recurrence.

Results: Baseline characteristics between the VSS and VPS groups were similar, including age, sex, body mass index, and preoperative opening pressure. Preoperative symptoms of headaches, papilledema, and tinnitus were also similar.

Initial headache improvement was comparable between the VSS and VPS cohorts (96% versus 91%), however headache recurrence was less common in the VSS group (31% versus 60%) at last neurosurgery follow-up, which averaged over 1 year in both groups. Multivariate analysis identified venous sinus stenting to be independently associated with reduced odds of headache recurrence (OR 0.24, p=0.015, 95% CI 0.08-0.76) after controlling for age, BMI, history of headache disorder, and post-operative follow-up duration. However, a longer follow-up duration was also associated with increased odds of headache recurrence in both groups (OR 1.01, p=0.032, 95% CI 1.01-1.02).

Conclusion : VSS was independently associated with reduced odds of headache recurrence over VPS in multivariate analysis, as was a shorter follow-up duration after VSS or VPS. This suggests that VSS may lead to better outcomes regarding continued headache relief, and that headache recurrence may be a function of follow-up duration rather than superiority of VPS for the treatment of IIH.