Venous Sinus Stenting using Transcranial Access for the Treatment of Idiopathic Intracranial Hypertension in a Pediatric Patient

A 4-year-old male with headaches, papilledema, intracranial hypertension, and bilateral transverse sinus (TS) stenosis underwent attempted percutaneous placement of a right TS stent. Stent deployment was not technically feasible due to the stiffness of the stent and tortuosity of the patient's jugular bulb. Therefore, the patient underwent hybrid endovascular stenting of the right TS using neuronavigation and direct access of the TS following a single burr hole craniectomy. Two Express 8 mm × 17 mm balloon-mounted stents were deployed into the right TS, which resulted in obliteration of the preexisting trans-stenosis pressure gradient and decreased intracranial parenchymal pressure as monitored through an intracranial pressure bolt. The patient's headaches and papilledema resolved, and follow-up imaging demonstrated no in-stent or stent-adjacent stenosis. This case demonstrates the feasibility of combining minimally invasive open surgical access to allow direct cannulation for venous sinus stenting.