Sequential Contralateral Venous Sinus Stenting for Persistent or Recurrent Symptoms Following Unilateral Stenting: A Single-Center Case Series

Sheizaf Shpilberg; Guy Elmakias; Michal Roitberg; Farouq Alguayn; Gal Ben-Arie; Israel Shenkman; Tamir Regev; Anat Horev

doi:10.1016/j.wneu.2026.125096

Sequential Contralateral Venous Sinus Stenting for Persistent or Recurrent Symptoms Following Unilateral Stenting: A Single-Center Case Series

World Neurosurg. 2026 Jun 2:212:125096. doi: 10.1016/j.wneu.2026.125096. Online ahead of print.

Authors

Sheizaf Shpilberg¹, Guy Elmakias¹, Michal Roitberg¹, Farouq Alguayn², Gal Ben-Arie³, Israel Shenkman³, Tamir Regev⁴, Anat Horev⁵

Affiliations

¹ Faculty of Health Sciences, Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer Sheva, Israel.
² Department of Neurosurgery, Soroka University Medical Center, Beer Sheva, Israel.
³ Department of Radiology, Soroka University Medical Center, Beer Sheva, Israel.
⁴ Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
⁵ Department of Neurology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel. Electronic address: anat.horev8@gmail.com.

PMID: 42235752
DOI: 10.1016/j.wneu.2026.125096

Abstract

Background: Cerebral venous sinus stenting (CVSS) is an established treatment for idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT). Despite frequent bilateral venous sinus stenosis, treatment is typically unilateral, and data on sequential contralateral stenting for persistent or recurrent symptoms remain limited.

Objective: To report safety and clinical outcomes of sequential contralateral CVSS in patients with incomplete or recurrent symptom improvement after technically successful unilateral stenting.

Methods: We conducted a retrospective single-center case series of patients who underwent contralateral CVSS between January 2019 and April 2025. Headache, papilledema, visual field defects, and PT were assessed using ordinal severity scales and a composite symptom severity score. Radiological findings, venous pressure gradients, procedural details, and complications were recorded. Longitudinal symptom severity changes were analyzed using nonparametric testing.

Results: Among 118 patients treated with unilateral CVSS, 16 (14%) underwent sequential contralateral stenting. All patients were female, with a median age of 30.5 (25-42) years. Papilledema resolved after the first CVSS and did not recur. Following contralateral CVSS, improvement occurred across symptom domains, including headache and PT, with complete resolution of significant visual field defects. The composite symptom severity score improved from 7 (5-9) before the first CVSS to 3 (2-3) after the procedure and to 1 (0-2) after contralateral stenting (P<0.0001). No intra- or post-procedural complications occurred.

Conclusions: In selected patients with persistent or recurrent symptoms after unilateral CVSS, sequential contralateral stenting appears safe and provides meaningful clinical benefit, supporting consideration of this approach and the need for prospective evaluation.

Keywords: Cerebral venous sinus stenting; Headache; Idiopathic intracranial hypertension; Papilledema; Pulsatile tinnitus; Venography; Venous sinus stenosis.