Therapeutic role of venous sinus stenting in pediatric IIH: evidence review for clinical practice.

backgroundIdiopathic intracranial hypertension (IIH) in children is a rare but vision-threatening condition characterized by elevated intracranial pressure (ICP) without an identifiable cause. While medical therapy remains the first-line approach, a subset of pediatric patients remains refractory, necessitating surgical or endovascular interventions. Venous sinus stenting (VSS) has emerged as a promising, minimally invasive alternative to cerebrospinal fluid (CSF) shunting, but its safety and efficacy in pediatric populations are not well-defined.

methodsA systematic literature review was conducted following PRISMA guidelines, focusing on pediatric patients (< 18 years) with medically refractory IIH treated with VSS. Databases searched included PubMed, ScienceDirect, Cochrane Library, and others, including studies published from January 1990 to September 2025. Data on patient selection, procedural outcomes, complications, and antiplatelet protocols were extracted and analyzed. Only studies rated ≥ 6 stars on the Newcastle-Ottawa Scale were included.

resultsSix primary studies were identified, reporting outcomes in 36 pediatric patients (mean age 13.32 ± 1.25 years). VSS led to marked improvement in headache (87.5%), papilledema (89.5%), and tinnitus (100%), with reduced need for acetazolamide in 66.7%. Complications included one retroperitoneal hematoma, decreased flow in the vein of Labbe and minor hemorrhagic events related to antiplatelet therapy, including epistaxis, menorrhagia, and oral bleeding leading to early discontinuation of clopidogrel. Persistent or recurrent symptoms after stenting underscore the need for individualized, multimodal evaluation, as standardized selection criteria for pediatric IIH are still lacking. The estimated retreatment rate across studies was approximately 20%, with re-stenting or CSF shunting required in select cases.

conclusionVSS appears to be a safe and effective treatment for selected pediatric IIH patients with venous sinus stenosis and demonstrable trans-stenotic gradients. However, its success relies heavily on appropriate patient selection and tailored antiplatelet management. Prospective pediatric studies and standardized guidelines are needed to clarify its optimal role in the therapeutic algorithm. Accordingly, our synthesis is intended to inform individualized decision-making in selected cases and does not constitute guideline-level recommendations.