2025 Proffered Presentations
S012: PREVALENCE OF VENOUS SINUS STENOSIS IN SPONTANEOUS CEREBROSPINAL FLUID LEAK AND THE ROLE FOR VENOUS SINUS STENTING: A SYSTEMATIC REVIEW AND META-ANALYSIS
Jenny B Xiao1; Carlos Khalil, MD2; Helen Hsiao1; Janiss Skulsampaopol, MD2; Daniel J Lee, MD, FRCSC2; Michael Cusimano, MD, FRCSC, DABNS, FACS, PhD, MHPE2; John M Lee, MD, MSc, FRCSC2; 1University of British Columbia; 2Department of Otolaryngology - Head and Neck Surgery, University of Toronto
Background: Current literature supports a strong association between spontaneous cerebrospinal fluid (sCSF) leak and idiopathic intracranial hypertension (IIH). There is also recent evidence which suggests a link between sCSF leak and venous sinus stenosis (VSS), a common feature found in IIH. This review aims to investigate the prevalence of VSS in sCSF leak as well as the role of venous sinus stenting for sCSF leak.
Methods: A protocol was registered in PROSPERO [CRD42024568270] which searched for studies of sCSF leaks that also investigated the prevalence of VSS. A search was conducted in four electronic databases: Medline (Ovid), Embase, CINAHL, and Cochrane CENTRAL from inception until July 11, 2024. Two reviewers independently screened citations and extracted data. Methodological quality was assessed using the Joanna Briggs Institute’s critical appraisal tool. Data was pooled using a random effects model to calculate overall prevalence and relative risk (RR).
Results: Thirteen studies met the final inclusion criteria with a total of 317 patients. The pooled prevalence of VSS in patients with sCSF leak was 0.71 (95% CI, 0.56–0.83, I2 = 74%). In two studies which investigated the presence of VSS in patients with sCSF leak, sCSF leak was associated with a greater risk of underlying VSS (RR = 3.11; 95% CI, 0.64–15.27, I2 = 87%), although this was not statistically significant. Eighty-five to 100% of patients with VSS who underwent venous sinus stenting as adjunctive therapy to surgical repair of sCSF leak or for medically refractive IIH demonstrated resolution of symptoms without sCSF leak recurrence at last follow-up.
Conclusion: VSS is common in patients with sCSF leak and adjunctive venous sinus stenting after surgical leak repair may be a therapeutic option for a subset of sCSF patients with VSS. Further studies are needed to investigate the association of VSS in sCSF leak and clarify the role of venous sinus stenting in conjunction with surgical repair of leaks.