Advanced treatment for Pseudotumor cerebri

Know the signs and symptoms associated with pseudotumor cerebri

Pseudotumor cerebri is a condition that occurs when pressure builds up in the skull. Typically there is no obvious reason for the pressure buildup, and the symptoms can resemble those of a brain tumor (when no tumor is present). This condition is also known as benign intracranial hypertension.

Shervin R. Dashti, M.D., Ph.D., endovascular neurosurgeon with Norton Neuroscience Institute, is offering patients advanced treatment options, resulting in life-changing outcomes in their ability to see more clearly.

In order to understand the treatment options, we first must understand the condition, explains Dr. Dashti. Pseudotumor cerebri, which is also refer to as benign intracranial hypertension, often affects young women and is the result of increased pressure in the skull, also known as intracranial pressure. This pressure can cause swelling of the optic nerve, resulting in loss of vision. The signs and symptoms associated with pseudotumor cerebri include:

  • Moderate to severe headaches originating behind the eyes; headaches worsen with eye movement
  • Ringing in the ears
  • Nausea, vomiting or dizziness
  • Blurred or dimmed vision
  • Brief episodes of blindness that typically last only a few seconds and can affect one or both eyes
  • Difficulty with peripheral vision (seeing to the side)
  • Double vision
  • Seeing light flashes
  • Neck, shoulder or back pain

Those at greatest risk for pseudotumor cerebri are women between the ages of 20 and 40 who are overweight. Even though the exact cause of pseudotumor cerebri is unknown in most cases, it may be linked to an excess amount of cerebrospinal fluid within the bony confines of the skull. Cerebrospinal fluid surrounds the brain and spinal cord, acting as a cushion to protect vital tissue from injury. It is produced in the brain and eventually absorbed into the bloodstream. The increased intracranial pressure of pseudotumor cerebri may be a result of a problem in the cerebrospinal fluid absorption process.

Dr. Dashti explains that our skulls only have so much space, and when there is a rise in cerebrospinal fluid volume causing increased intracranial pressure, it can impact a person’s vision.

Medical treatment for pseudotumor cerebri is very limited. Acetazolamide is the most commonly used medication for the condition but has very limited effectiveness, and it is usually associated with significant side effects. Typical surgical treatment requires the placement of a shunt (long, thin tube) into the brain or lower spine to help drain excess cerebrospinal fluid. Complications associated with the shunt include potential infection, low-pressure headaches and the shunt can become clogged. Shunt failure rates within one year are in the 50 to 75 percent range.

Fortunately, there has been a new and exciting development in our understanding and treatment of pseudotumor cerebri. Several recent reports have shown narrowing of the major draining vein in the brain (venous sinus stenosis) occurs in the majority of pseudotumor cerebri patients. This may cause increased pressure in the veins of the brain, which lead to decreased cerebrospinal fluid absorption and increased intracranial pressure. Recent studies have shown that placing a stent in the narrowed venous sinus in these patients results in a very high cure rate for pseudotumor cerebri.

Dr. Dashti shared that in a recent review of the literature covering 143 patients, 97 percent demonstrated improvement or resolution of optic nerve swelling; 62 percent experienced improvement of visual symptoms; and 88 percent of patients experienced headache improvement.

“These results are far superior to any previously recognized treatment for pseudotumor cerebri,” said Dr. Dashti.

This advanced, noninvasive treatment is only offered at a few centers around the country. Dr. Dashti and his team perform two to three venous sinus stenting procedures for pseudotumor cerebri per month. The endovascular stent placement is performed similar to a heart catheterization, through the groin under the guide of X-ray technology. Dr. Dashti guides the stent through the vein to the desired location and releases it to open the narrowing. The patients are usually observed overnight after the procedure and then discharged home the following morning.

The stent placement also seems to be offering long-term relief, according to Dr. Dashti. Most patients are seeing vast improvements, if not reversal in their symptoms, with this procedure.

Post-procedure treatment includes the use of aspirin and a drug that prevents blood clots for three months, then a continuous aspirin regimen. Patients must continue to be monitored by their ophthalmologist and neurologist on a routine basis.


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