Dural Venous Sinus Stenting in Pediatric Refractory Idiopathic Intracranial Hypertension: A Case Series and Literature Review.

Abstract

Management of pediatric idiopathic intracranial hypertension (IIH) presents significant challenges. Although venous sinus stenting has emerged as an effective minimally invasive treatment for adult IIH, its efficacy and safety in the pediatric population is not well studied. Three cases of pediatric IIH refractory to medical management and treated with venous sinus stenting were retrospectively reviewed. The first case, a 17-year-old girl with a body mass index (BMI) of 57.06 kg/m², cerebrospinal fluid (CSF) opening pressure of 38 cm H₂O, and a pressure gradient of 15 mm Hg across the venous sinus stenosis, presented with bilateral optic disc edema, visual deficits, and a worsening 3-day headache. The second case, a 14-year-old girl with a BMI of 57.06 kg/m², CSF opening pressure of 28 cm H₂O, and a pressure gradient of 12 mm Hg across the venous sinus stenosis presented with bilateral optic disc edema, visual deficits, nausea, and headache. The last case, a 12-year-old girl with a BMI of 30.47 kg/m², opening pressure of 39.5 cm H₂O, and a pressure gradient of 7 mm Hg across the venous sinus stenosis, presented with diplopia, headache, and ataxia. All cases had been managed medically with acetazolamide before venous stenting. All 3 patients demonstrated symptomatic and visual improvement at 6-month follow-up, and there were no major surgical complications noted in these patients. Although IIH is difficult to manage in the pediatric population, we report successful implementation of venous sinus stenting in the management of pediatric IIH. There were no major operative complications.