Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Systematic Review of an Emerging Intervention with Favorable Outcomes but Unresolved Standardization

Abstract

Background: Dural venous sinus stenosis is increasingly implicated in idiopathic intracranial hypertension, and venous sinus stenting (VSS) has emerged as a therapeutic option. Current evidence is observational and based almost exclusively on off-label stent platforms.

Methods: This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review (International Prospective Register of Systematic Reviews [PROSPERO] CRD420261369492) searched MEDLINE, Scopus, and Web of Science from inception through May 2025 for adult studies of VSS in idiopathic intracranial hypertension, including all eligible studies published up to that date. Two reviewers independently screened, extracted data, and appraised quality with a modified Newcastle-Ottawa Scale (0-16). Certainty of evidence for papilledema resolution, headache improvement, and major complications was rated with Grading of Recommendations, Assessment, Development, and Evaluation.

Results: Nineteen studies on 1210 patients were included: predominantly retrospective single-center cohorts, 2 case series, 2 pilot studies, and one multicenter administrative database analysis (Nia et al.), which alone contributed 541 patients through International Classification of Diseases, 10th Revision and Current Procedural Terminology coding. Mean age ranged from 29 to 43 years; women were 67%-100%. Trans-stenotic pressure gradients fell from 9 to 29 mmHg prestenting to near-zero values. Papilledema resolution ranged from 36% to 100%, headache improvement 13%-100%, and major complications 0%-9.6%. Newcastle-Ottawa Scale scores ranged from 6 to 11 (median: 7). Heterogeneity in outcome definitions and ascertainment, including administrative coding in Nia et al., precluded pooling. Grading of Recommendations, Assessment, Development, and Evaluation certainty was very low for all 3 outcomes.

Conclusions: VSS is associated with reliable hemodynamic correction and frequent improvement in papilledema and pulsatile tinnitus; headache response is variable and major complications infrequent. Very low certainty precludes firm recommendations. Standardized outcome definitions and prospective multicenter trials of dedicated venous stents are needed.

Keywords: Idiopathic intracranial hypertension; Pressure gradient; Pseudotumor cerebri syndrome; Transverse sinus; Venous stenting.