1092 Venous Sinus Stenting for Fulminant Idiopathic Intracranial Hypertension Patients

INTRODUCTION: Idiopathic intracranial hypertension (IIH) can rarely present with acute onset, rapidly worsening headaches and visual loss which require urgent intervention. However, few studies have examined the outcomes of venous sinus stenting (VSS) for fulminant symptoms patients with IIH. METHODS: We conducted a retrospective review of fulminant IIH patients treated with VSS at our institution from 2015 to 2025, examining their clinical presentation, treatment details, and follow-up outcomes. RESULTS: Fulminant IIH was present in 17 patients (mean age: 33.1 ± 13.5, mean BMI: 38.7 ± 8.3), with 88.2% reporting headaches, 35.3% tinnitus, 94.1% papilledema, and 94.1% acutely progressive vision loss. The mean lumbar puncture opening pressure (OP) was 43 ± 12.5 cm H2O, with a pre-VSS TSJ pressure gradient of 32.4 ± 18.5 mm Hg and TSJ stenosis of 55.1% ± 13.4%. Intraoperatively, TSJ pressure gradient resolution was achieved in all patients with post-VSS manometry. The mean clinical follow-up was 770.5 ± 547.0 days. Symptom resolution included headache in 93.4%, visual symptoms in 76.5%, tinnitus in 100%, and papilledema in 71.4%. Temporary improvement with recurrence occurred in 29.4% (headache: 26.7%, visual: 5.9%, tinnitus: 16.7%, papilledema: 21.4%) at an average of 370 days post-VSS. Symptoms worsened or remained unchanged in 29.4% (headache: 6.7%, visual: 23.5%, papilledema: 7.1%). Follow-up lumbar OP averaged 26.7 ± 10.2 cm H2O. One patient underwent bariatric surgery and no patient required subsequent CSF-diversion procedures. Six (35.3%) patients underwent angiographic follow-up, revealing re-stenosis and elevated TSJ pressure gradient in 3 (17.6%) patients, all of whom underwent re-stenting. CONCLUSIONS: We present the largest series to date on the safety and efficacy of VSS in fulminant IIH patients requiring emergent treatment. VSS resulted in high rates of symptomatic improvement, although restenosis and retreatment rates were higher than those observed in non-fulminant IIH patients.