National Trends of Cerebral Venous Sinus Stenting for the Treatment of Idiopathic Intracranial Hypertension.

BACKGROUND: Cerebral venous sinus stenting (VSS) has emerged as a new surgical procedure for the treatment of severe IIH, and its popularity has been anecdotally on the rise. This study explores recent temporal trends of VSS and other surgical IIH treatments in the United States.

METHODS: Adult IIH patients were identified from the 2016-20 National Inpatient Sample databases, and surgical procedures and hospital characteristics were recorded. Temporal trends of procedure numbers for VSS, cerebrospinal fluid (CSF) shunts, and optic nerve sheath fenestrations (ONSF) were assessed and compared.

RESULTS: 46,065 [95%CI: 44,710-47,420] IIH patients were identified, of whom 7,535 patients [95%CI: 6,982-8,088] received surgical IIH treatments. VSS procedures increased 80% (150 [95%CI: 55-245] to 270 [95%CI: 162-378] per year, p<0.001). Concurrently, the number of CSF shunts decreased by 19% (1365 [95%CI: 1,126-1,604] to 1105 [95%CI: 900-1,310] per year, p<0.001), and ONSF procedures decreased by 54% (65 [95%CI: 20-110] to 30 [95%CI: 6-54] per year, p<0.001).

CONCLUSIONS: Practice patterns for surgical IIH treatment in the United States are rapidly evolving, and VSS is becoming increasingly common. These findings highlight the urgency of randomized controlled trials to investigate the comparative effectiveness and safety of VSS, CSF shunts, ONSF, and standard medical treatments.