Venous Sinus Stenosis Treatment in Pediatric Idiopathic Intracranial Hypertension: Illustrative Case and Literature Review.

Abstract Objective To review the literature of venous sinus stenosis treatment in children for idiopathic intracranial hypertension and present our own institutional case. Methods A literature review was conducted using the PubMed and Medline databases until June of 2020. 134 studies were screened, and six studies were chosen for analysis that included patients less than 18 years of age, diagnosis of idiopathic intracranial hypertension that fit Dandy criteria for diagnosis, and angiogram performed assessing for venous sinus stenosis. Analysis was performed to review IIH symptoms experienced in the pediatric population as well as efficacy of venous sinus stenting. Results Eleven patients identified in the literature along with one patient from our own institution were included in the analysis. There was no statistically significant difference in pressure gradient response to stenting between sex (p = 0.424) or those with BMI greater than 90th percentile (p = 0.626). Larger decreases in pressure gradient after stent placement correlated with headache resolution (p = 0.0005). Patients who underwent unilateral stenting showed greater reduction in pressure gradient compared to bilateral stenting (average change 24 vs 5.75, p = 0.003). Conclusion Our analysis show that VSS treatment has the potential to be a safe option for IIH in the pediatric population. VSS treatment has shown similar results to the traditional cerebrospinal fluid diversion procedures, with a lower complication rate and need for revision. We believe more studies should be conducted to analyze the long-term efficacy and safety of VSS treatment in the pediatric IIH population.