Effect of body mass index on venous sinus pressures in idiopathic intracranial hypertension patients before and after endovascular stenting

Daniel M.S. Raper, Dale Ding, Thomas J. Buell, R. Webster Crowley, Robert M. Starke, Kenneth Liu

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND:Elevated body mass index (BMI) has been correlated withworse outcomes after treatment for idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a safe and effective treatment for a subset of patients with IIH and evidence of venous sinus stenosis. However, the association between BMI and the efficacy of VSS remains poorly characterized. OBJECTIVE: To determine, in a retrospective cohort study, the effect of BMI on preoperative mean intracranial venous pressure (MVP) and post-VSS outcomes. METHODS:We performed a retrospective evaluation of a prospectively collected database of patients with IIH and intracranial venous sinus stenosis who underwent VSS. Patient demographics and treatment factors, including pre-and postprocedural trans-stenosis pressure gradients, were analyzed to identify the relationship between BMI and outcomes after VSS. RESULTS: Increasing BMI was significantly correlated with higher maximumMVP (P=.013) and higher trans-stenosis pressure gradient (P = .043) prior to treatment. The degrees of improvement in maximum MVP and pressure gradient after VSS were greatest for obese and morbidly obese patients (BMI > 30 kg/m2). Maximum poststent MVP, clinical outcomes, and stent-adjacent stenosis requiring retreatment after VSS were not significantly associated with BMI. CONCLUSION: We provide direct evidence for a positive correlation between BMI and intracranial venous pressure in patients with IIH. VSS affords a significantly greater amelioration of intracranial venous hypertension and stenosis for IIH patients with higher BMIs. As such, obesity should not be a deterrent for the use of VSS in the management of IIH.

Original languageEnglish (US)
Pages (from-to)555-561
Number of pages7
JournalNeurosurgery
Volume82
Issue number4
DOIs
StatePublished - Apr 1 2018

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Pseudotumor Cerebri
Venous Pressure
Body Mass Index
Pathologic Constriction
Intracranial Pressure
Pressure
Cranial Sinuses
Cohort Effect
Retreatment
Intracranial Hypertension
Stents
Cohort Studies
Therapeutics
Retrospective Studies
Obesity
Demography
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Raper, Daniel M.S. ; Ding, Dale ; Buell, Thomas J. ; Crowley, R. Webster ; Starke, Robert M. ; Liu, Kenneth. / Effect of body mass index on venous sinus pressures in idiopathic intracranial hypertension patients before and after endovascular stenting. In: Neurosurgery. 2018 ; Vol. 82, No. 4. pp. 555-561.
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Effect of body mass index on venous sinus pressures in idiopathic intracranial hypertension patients before and after endovascular stenting. / Raper, Daniel M.S.; Ding, Dale; Buell, Thomas J.; Crowley, R. Webster; Starke, Robert M.; Liu, Kenneth.

In: Neurosurgery, Vol. 82, No. 4, 01.04.2018, p. 555-561.

Research output: Contribution to journalArticle

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T1 - Effect of body mass index on venous sinus pressures in idiopathic intracranial hypertension patients before and after endovascular stenting

AU - Raper, Daniel M.S.

AU - Ding, Dale

AU - Buell, Thomas J.

AU - Crowley, R. Webster

AU - Starke, Robert M.

AU - Liu, Kenneth

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N2 - BACKGROUND:Elevated body mass index (BMI) has been correlated withworse outcomes after treatment for idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a safe and effective treatment for a subset of patients with IIH and evidence of venous sinus stenosis. However, the association between BMI and the efficacy of VSS remains poorly characterized. OBJECTIVE: To determine, in a retrospective cohort study, the effect of BMI on preoperative mean intracranial venous pressure (MVP) and post-VSS outcomes. METHODS:We performed a retrospective evaluation of a prospectively collected database of patients with IIH and intracranial venous sinus stenosis who underwent VSS. Patient demographics and treatment factors, including pre-and postprocedural trans-stenosis pressure gradients, were analyzed to identify the relationship between BMI and outcomes after VSS. RESULTS: Increasing BMI was significantly correlated with higher maximumMVP (P=.013) and higher trans-stenosis pressure gradient (P = .043) prior to treatment. The degrees of improvement in maximum MVP and pressure gradient after VSS were greatest for obese and morbidly obese patients (BMI > 30 kg/m2). Maximum poststent MVP, clinical outcomes, and stent-adjacent stenosis requiring retreatment after VSS were not significantly associated with BMI. CONCLUSION: We provide direct evidence for a positive correlation between BMI and intracranial venous pressure in patients with IIH. VSS affords a significantly greater amelioration of intracranial venous hypertension and stenosis for IIH patients with higher BMIs. As such, obesity should not be a deterrent for the use of VSS in the management of IIH.

AB - BACKGROUND:Elevated body mass index (BMI) has been correlated withworse outcomes after treatment for idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a safe and effective treatment for a subset of patients with IIH and evidence of venous sinus stenosis. However, the association between BMI and the efficacy of VSS remains poorly characterized. OBJECTIVE: To determine, in a retrospective cohort study, the effect of BMI on preoperative mean intracranial venous pressure (MVP) and post-VSS outcomes. METHODS:We performed a retrospective evaluation of a prospectively collected database of patients with IIH and intracranial venous sinus stenosis who underwent VSS. Patient demographics and treatment factors, including pre-and postprocedural trans-stenosis pressure gradients, were analyzed to identify the relationship between BMI and outcomes after VSS. RESULTS: Increasing BMI was significantly correlated with higher maximumMVP (P=.013) and higher trans-stenosis pressure gradient (P = .043) prior to treatment. The degrees of improvement in maximum MVP and pressure gradient after VSS were greatest for obese and morbidly obese patients (BMI > 30 kg/m2). Maximum poststent MVP, clinical outcomes, and stent-adjacent stenosis requiring retreatment after VSS were not significantly associated with BMI. CONCLUSION: We provide direct evidence for a positive correlation between BMI and intracranial venous pressure in patients with IIH. VSS affords a significantly greater amelioration of intracranial venous hypertension and stenosis for IIH patients with higher BMIs. As such, obesity should not be a deterrent for the use of VSS in the management of IIH.

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