Abstract：
Chronically elevated intracranial pressure (ICP) seen in idiopathic intracranial hypertension (IIH) can cause the development of skull base encephaloceles and cerebrospinal fluid (CSF) leaks. Surgical repair and ventriculoperitoneal shunt (VPS) placement are mainstays of treatment. Venous sinus stenting (VSS) is a newly accepted treatment modality. The goal of this study was thus to determine if VSS can be used to treat symptoms and prevent recurrence after surgical encephalocele repair.
Retrospective chart review of patients that had surgical repair of encephaloceles followed by VSS for symptomatic stenosis with elevated pressure gradient.
A total of 13 patients underwent a combined encephalocele repair and VSS. Seventy-two percent were female; 46% had headaches, 69% pulsatile tinnitus, and 92% CSF rhinorrhea or otorrhea. One had seizures. Mean lumbar opening pressure was 23.3 ± 2.6 cm H2O; the average sagittal-to-jugular pressure gradient was 12.7 ± 1.8 cmH2O and was elevated in all patients. Four patients had middle fossa craniotomy for repair of tegmen defect (one bilateral); one had a retrosigmoid craniotomy for repair of a sigmoid plate defect. Eight had an endoscopic endonasal repair for sphenoid or cribriform plate encephalocele. There were no VSS procedural complications or complications associated with dual antiplatelet therapy. One patient had meningitis after endoscopic repair that was treated with antibiotics. One patient had recurrence of both CSF leak and venous stenosis adjacent to the stent requiring repeat repair and VSS. There was no further recurrence.
In patients with dural sinus stenosis and encephaloceles requiring repair, VSS can be performed safely within weeks of surgery for relief of symptoms, resolution of underlying pathology, and prevention of CSF leak recurrence.
Retrospective chart review of patients that had surgical repair of encephaloceles followed by VSS for symptomatic stenosis with elevated pressure gradient.
A total of 13 patients underwent a combined encephalocele repair and VSS. Seventy-two percent were female; 46% had headaches, 69% pulsatile tinnitus, and 92% CSF rhinorrhea or otorrhea. One had seizures. Mean lumbar opening pressure was 23.3 ± 2.6 cm H2O; the average sagittal-to-jugular pressure gradient was 12.7 ± 1.8 cmH2O and was elevated in all patients. Four patients had middle fossa craniotomy for repair of tegmen defect (one bilateral); one had a retrosigmoid craniotomy for repair of a sigmoid plate defect. Eight had an endoscopic endonasal repair for sphenoid or cribriform plate encephalocele. There were no VSS procedural complications or complications associated with dual antiplatelet therapy. One patient had meningitis after endoscopic repair that was treated with antibiotics. One patient had recurrence of both CSF leak and venous stenosis adjacent to the stent requiring repeat repair and VSS. There was no further recurrence.
In patients with dural sinus stenosis and encephaloceles requiring repair, VSS can be performed safely within weeks of surgery for relief of symptoms, resolution of underlying pathology, and prevention of CSF leak recurrence.
摘要：
背景：在特发性颅内高压（IIH）中观察到的颅内压（ICP）慢性升高可导致颅底脑病和脑脊液（CSF）泄漏的发展。手术修复和脑室腹腔分流术（VPS）放置是治疗的主要内容。静脉窦支架置入术（VSS）是一种新接受的治疗方式。因此，这项研究的目的是确定VSS是否可用于治疗症状并预防手术脑膨出修复后的复发。
方法：回顾性图表回顾分析了因压力梯度升高的症状性狭窄而接受脑囊肿修复后接受VSS治疗的患者。
结果：共有13例患者接受了脑膨出修复和VSS联合治疗。72％是女性；46％的人头痛，69%脉动性耳鸣,和92%的脑脊液鼻漏或耳漏。一个人癫痫发作。平均腰椎开放压力为23.3±2.6cmH2O；平均矢状到颈静脉的压力梯度为12.7±1.8cmH2O，所有患者均升高。四名患者进行了中颅窝开颅手术以修复tegmen缺损（一个双侧）；一个人进行了乙状结肠后颅开颅手术以修复乙状结肠板缺损。八个人接受了内窥镜鼻内修复术治疗蝶骨或筛板脑膨出。没有VSS手术并发症或与双重抗血小板治疗相关的并发症。一名患者在内窥镜修复后用抗生素治疗患有脑膜炎。一名患者在支架附近复发了CSF泄漏和静脉狭窄，需要重复修复和VSS。没有进一步的复发。
结论：在硬脑膜窦狭窄和脑囊肿需要修复的患者中，VSS可以在手术后几周内安全地进行，以缓解症状，基础病理学的分辨率，和预防脑脊液漏复发。
方法：回顾性图表回顾分析了因压力梯度升高的症状性狭窄而接受脑囊肿修复后接受VSS治疗的患者。
结果：共有13例患者接受了脑膨出修复和VSS联合治疗。72％是女性；46％的人头痛，69%脉动性耳鸣,和92%的脑脊液鼻漏或耳漏。一个人癫痫发作。平均腰椎开放压力为23.3±2.6cmH2O；平均矢状到颈静脉的压力梯度为12.7±1.8cmH2O，所有患者均升高。四名患者进行了中颅窝开颅手术以修复tegmen缺损（一个双侧）；一个人进行了乙状结肠后颅开颅手术以修复乙状结肠板缺损。八个人接受了内窥镜鼻内修复术治疗蝶骨或筛板脑膨出。没有VSS手术并发症或与双重抗血小板治疗相关的并发症。一名患者在内窥镜修复后用抗生素治疗患有脑膜炎。一名患者在支架附近复发了CSF泄漏和静脉狭窄，需要重复修复和VSS。没有进一步的复发。
结论：在硬脑膜窦狭窄和脑囊肿需要修复的患者中，VSS可以在手术后几周内安全地进行，以缓解症状，基础病理学的分辨率，和预防脑脊液漏复发。
