Venous sinus stenting after repair of skull base spontaneous cerebrospinal fluid leaks: A single-center retrospective cohort series with case-control analysis - 28/07/21

Doi : 10.1016/j.neurad.2021.07.002

Marc-Antoine Labeyrie ^a,^⁎ , Vincent Bedarida ^b, Ursulla Vever ^c, Alexis Guedon ^a, Philippe Herman ^b, Benjamin Verillaud ^b, Emmanuel Houdart ^a
^a Interventional Neuroradiology department, Hôpital Lariboisière, Université de Paris, France
^b Otorhinolaryngology department, Hôpital Lariboisière, Inserm U1141, Université de Paris, France
^c Neurology department, Hôpital Lariboisière, Université de Paris, France

^⁎Corresponding author at: Interventional Neuroradiology, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France.Interventional NeuroradiologyHôpital Lariboisière2 rue Ambroise ParéParis75010France

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Highlights

•	Spontaneous CSF leaks of skull base are linked with intracranial hypertension.
•	Venous sinus stenting is promising treatment for intracranial hypertension.
•	Venous sinus stenting may decrease leak recurrence after skull base repair.

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Abstract

Background

Management of idiopathic intracranial hypertension (IIH) is recommended after surgical repair of spontaneous cerebrospinal fluid leaks (sCSF-leaks) of the skull base for prevention of recurrence.

Purpose

To assess the feasibility of venous sinus stenting, a treatment commonly used for the treatment of IIH associated with intracranial venous sinus stenosis (VSS), after sCSF-leaks closure.

Materials and methods

A single-center cohort series of consecutive patients who underwent sCSF-leak closure was retrospectively analyzed. Stenting was considered either for leak recurrence or in prophylactic manner after repair in patients with VSS as confirmed by cerebral venous imaging. Leak recurrence, need for new repair or adjunctive treatment of IIH, meningitis, and stenting complications were determined at the last follow-up. Cases who had prophylactic stenting were compared to historical controls before stenting option.

Results

Twenty-two patients had intracranial venous stenting after sCSF-leak closure. Their median age was 58 years (Q1=45; Q3=68), BMI=31 kg.m⁻² (Q1=27; Q3=36), and female rate=85%. The overall rate of successful repair after stenting was 95% (95% CI = 87–100%) at a median follow-up of 2.4 years (Q1=1.2; Q3=3.3). Adjunctive treatment for IIH was needed in 4 patients (4/22, 18%) including 2 patients without leak recurrence. No meningitis, permanent morbidity or mortality was observed after stenting. Compared to 18 controls, cases had significantly less recurrence (P = 0.03), and a trend for less adjunctive treatment for IIH (P = 0.06).

Conclusions

Our study suggests that stenting might be a valid option for prevention of sCSF-leak recurrences after repair in patients with intracranial venous sinus stenosis.

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