Predicting the Rapid Improvement of Papilledema After Stenting in Idiopathic Intracranial Hypertension

Abstract

Purpose: This study aimed to identify predictors of rapid improvement of papilledema after stenting and develop a simple preintervention scale.

Methods: A prospective cohort of idiopathic intracranial hypertension (IIH) with venous sinus stenosis (VSS) treated with stenting in a tertiary hospital from January 2014 to December 2019 was reviewed. We categorized papilledema improvement into favorable (grades 0-1) and unfavorable (grades 2-5). We employed logistic regression analysis to find the predictive factors and develop the predictive scale. We then estimated the performance of the scale using the ROC curve and Hosmer-Lemeshow test.

Results: There were 110 patients who underwent venous sinus stenting, with a mean age of 37.1 years and a predominance of females (77.3%). A total of 85 patients had a favorable outcome following stenting, while 25 patients had an unfavorable outcome. The results of the multivariate analysis indicate that lower preoperative pressure gradients (odds ratio, OR: 4.01; 95% confidence interval, CI: 1.27-12.68), stenosis rates (OR: 4.16; 95% CI: 1.11-15.56), and preoperative papilledema grades (OR: 2.92; 95% CI: 1.44-5.91) were independently associated with rapid improvement of papilledema following stenting treatment. The 3‑item scale exhibited good discrimination with an area under the curve (AOC) of 0.81 (95% CI 0.72-0.89, p < 0.001), as well as acceptable calibration determined by the Hosmer-Lemeshow test (P = 0.42). The optimal cut-off value of the scale (range 0-6 points) was ≥ 4 points, with a sensitivity of 72%, specificity of 73%, and accuracy of 78%.

Conclusion: The presence of lower preoperative pressure gradients, stenosis severity, and preoperative status of papilledema were identified as positive predictors of rapid improvement of the papilledema following stenting in IIH patients. The 3‑item scale provides a promising preintervention predictive model for predicting rapid response following stenting treatment in IIH patients with VSS.

Keywords: IIH; Outcomes; Sinus stenosis; Stenting; Treatment.