TY - JOUR
T1 - Venous sinus stenting for management of spontaneous skull-base CSF leaks
T2 - A systematic review and meta-analysis
AU - Rasmussen, Jordan M.
AU - Patel, Kautilya R.
AU - Surdell, Daniel L.
AU - Thorell, William E.
AU - Borg, Nicholas
AU - Opperman, Patrick J.
AU - Casazza, Geoffrey
AU - Maxwell, Anne K.
AU - Barnes, Christie A
AU - Pate, Samuel
AU - Schmidt, Cynthia M
AU - Sattur, Mithun G.
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025
Y1 - 2025
N2 - Background: Idiopathic intracranial hypertension (IIH) is strongly associated with spontaneous skull-base cerebrospinal fluid (CSF) leaks. Venous sinus stenting (VSS) has proven effective for the treatment of IIH. Hence, its role in spontaneous skull-base CSF leaks is being explored actively. Methods: We performed a systematic literature search across EMBASE, MEDLINE, Scopus, The Cochrane Library, and Google Scholar to identify studies reporting the use of VSS for spontaneous skull-base CSF leaks. Studies with pediatric patients, non-English articles, and nonspontaneous leaks were excluded. Failure of treatment (persistence / recurrence of CSF leak) was regarded as the primary outcome. Results: Eight studies with 62 patients undergoing VSS for spontaneous skull-base CSF leaks were included. Mean age of the patients was 51.9 years; 87.5% were females. Obesity was highly prevalent, with a mean body mass index of 33.9 kg/m2 (4 studies). IIH was noted in 74.6% patients (7 studies). Twenty-six patients (41.9%) underwent VSS alone whereas 36 patients (58.1%) underwent surgical repair + VSS. Seven patients (11.3%) had a failure of treatment. Three failures from one study could not be definitively ascribed to either of the groups. Hence, the estimated failure rate for VSS alone ranged from 18.6% (95% CI [0.02 – 0.46]) to 26.4% (95% CI [0.11 – 0.46]), whereas that for surgical repair + VSS ranged from 5.5% (95% CI [0.00 – 0.16]) to 12.2% (95% CI [0.01 – 0.32]). Furthermore, the estimated rate for resolution of concomitant IIH-related symptoms was 88.7% (95% CI [0.75 – 0.98%]). Majority of the studies did not report any serious complications or mortality related to VSS. Conclusion: VSS has a potential role in the management of spontaneous skull-base CSF leaks. Its exact indications as a standalone treatment versus as an adjuvant to surgical repair, and the predictors for successful treatment remain to be defined.
AB - Background: Idiopathic intracranial hypertension (IIH) is strongly associated with spontaneous skull-base cerebrospinal fluid (CSF) leaks. Venous sinus stenting (VSS) has proven effective for the treatment of IIH. Hence, its role in spontaneous skull-base CSF leaks is being explored actively. Methods: We performed a systematic literature search across EMBASE, MEDLINE, Scopus, The Cochrane Library, and Google Scholar to identify studies reporting the use of VSS for spontaneous skull-base CSF leaks. Studies with pediatric patients, non-English articles, and nonspontaneous leaks were excluded. Failure of treatment (persistence / recurrence of CSF leak) was regarded as the primary outcome. Results: Eight studies with 62 patients undergoing VSS for spontaneous skull-base CSF leaks were included. Mean age of the patients was 51.9 years; 87.5% were females. Obesity was highly prevalent, with a mean body mass index of 33.9 kg/m2 (4 studies). IIH was noted in 74.6% patients (7 studies). Twenty-six patients (41.9%) underwent VSS alone whereas 36 patients (58.1%) underwent surgical repair + VSS. Seven patients (11.3%) had a failure of treatment. Three failures from one study could not be definitively ascribed to either of the groups. Hence, the estimated failure rate for VSS alone ranged from 18.6% (95% CI [0.02 – 0.46]) to 26.4% (95% CI [0.11 – 0.46]), whereas that for surgical repair + VSS ranged from 5.5% (95% CI [0.00 – 0.16]) to 12.2% (95% CI [0.01 – 0.32]). Furthermore, the estimated rate for resolution of concomitant IIH-related symptoms was 88.7% (95% CI [0.75 – 0.98%]). Majority of the studies did not report any serious complications or mortality related to VSS. Conclusion: VSS has a potential role in the management of spontaneous skull-base CSF leaks. Its exact indications as a standalone treatment versus as an adjuvant to surgical repair, and the predictors for successful treatment remain to be defined.
KW - idiopathic intracranial hypertension
KW - intracranial pressure
KW - spontaneous CSF leak
KW - spontaneous skull base CSF leak
KW - transverse sinus stenosis
KW - transverse sinus stenting
KW - Venous sinus stenting
UR - http://www.scopus.com/inward/record.url?scp=85217051081&partnerID=8YFLogxK
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U2 - 10.1177/15910199241311626
DO - 10.1177/15910199241311626
M3 - Review article
C2 - 39915985
AN - SCOPUS:85217051081
SN - 1591-0199
JO - Interventional Neuroradiology
JF - Interventional Neuroradiology
ER -