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目的 探讨静脉窦支架成形术治疗特发性颅高压综合征(IIH)合并静脉窦狭窄(CVSS)的有效性和安全性.方法 回顾性分析2013年1月至2017年1月郑州大学第一附属医院接受静脉窦支架成形术治疗的18例患者资料.介入治疗纳入标准为符合IIH诊断标准,眼科检查提示视乳头水肿,经正规药物治疗无效的顽固性IIH或短期视力进行性下降的爆发性IIH,且经MR静脉成像或DSA证实CVSS,逆行性静脉窦测压狭窄两端的压力差≥10 mmHg(1 mmHg=0.133 kPa).患者行动静脉造影及逆行性静脉窦测压,而后接受静脉窦支架成形术治疗.术后7d,腰椎穿刺测量颅内压.随访6~48个月,术后6个月行DSA观察支架内有无再狭窄及评价支架开放情况,评价治疗效果,观察不良反应.采用配对t检验(计数资料,符合正态分布)比较治疗前、后狭窄远端和近端的压力差及颅内压的差异.结果18例均成功行单侧静脉窦支架成形术,将支架放置在压力差最大的狭窄部位.支架植入后狭窄远端和近端的压力差降至(2.5±2.1)mmHg,与治疗前的(31.5±11.4)mmHg差异有统计学意义(t=10.96,P<0.05);颅内压由术前(385 ± 72)mmH2O(1 mmH2O=0.0098 kPa)降至术后(201 ± 24) mmH2O,差异有统计学意义(t=13.02,P<0.05).治疗后6个月复查DSA,所有患者支架开放良好,无支架内再狭窄.3例(3/16)患者仍间断出现头痛但无需特殊治疗,其余患者头痛缓解;14例(14/17)视觉症状消失;18例患者视乳头水肿均明显好转或消失;8例搏动性耳鸣消失.随访期间所有患者症状无复发.无严重不良反应发生.结论 对于存在静脉窦狭窄的顽固性IIH患者,静脉窦支架成形术是一种安全、有效的治疗方法.

Objective To explore the efficacy and safety of venous sinus stenting in the treatment of refractory idiopathic intracranial hypertension (IIH) complicated with venous sinus stenosis. Methods We reviewed our clinical database for 18 patients with resistant or fulminant IIH and cerebral venous sinus stenosis,who underwent placement of venous sinus stents between January 2013 and December 2016. Patients were considered eligible for stenting based on the following criteria: (1) medically refractory IIH;(2)papilledema confirmed by an ophthalmologist;and(3)dural venous sinus stenosis of the dominant venous outflow system with a gradient of ≥10 mmHg(1 mmHg=0.133 kPa). Prior to intervention, diagnostic angiography and venous pressure measurements were performed. Clinical follow-up was available in all patients at 6 to 48 months after stenting.Angiography to evaluate stent patency and restenosis was performed at 6 months after intervention;Relevant clinical, demographic and radiographic data were extracted after review of these records. The paired t test was used to compare the changes before and after the operation. Results The mean lumbar CSF pressure was reduced from (385±72) mmH2O(1 mmH2O=0.009 8 kPa) to (201±24)mmH2O(t=13.02,P<0.05).The mean pressure gradient across the venous stenosis was reduced from(31.5±11.4)mmHg before the procedure to(2.5±2.1)mmHg(t=10.96,P<0.05).Headache in 13 cases,vision in 14 were resolved. Papilledema and pulsatile tinnitus resolved in all patients. There was no instances of restenosis among the 18 patients with follow-up imaging.Conclusion In patients with IIH and documented evidence of venous sinus stenosis with a high pressure gradient,venous sinus senting represents an effective treatment strategy.