Neurosurgery 99:700–709, 2026
Venous sinus stenting for idiopathic intracranial hypertension is commonly separated into diagnostic manometry under conscious sedation and later stenting under general anesthesia. This cohort asks whether conscious sedation and a more streamlined pathway can deliver comparable safety and efficacy. After propensity matching, outcomes did not differ significantly between conscious sedation and general anesthesia. Same-admission diagnosis and treatment were associated with more repeat stenting, although this group included every fulminant presentation. The work supports outpatient feasibility but not indiscriminate conversion to a single-session pathway.
Objective
To compare venous sinus stenting under conscious sedation and general anesthesia and to evaluate single-session diagnostic venography plus stenting versus staged procedures, with particular attention to outpatient management.
Methods
The retrospective cohort included 114 adults treated for idiopathic intracranial hypertension at one comprehensive cerebrovascular center from January 2017 through December 2024. Clinical presentation, procedural characteristics, symptom resolution and restenosis were compared between general anesthesia and conscious sedation and between same-admission and staged pathways. Propensity-score matching was used for both comparisons.
Main results
Thirty-six patients underwent general anesthesia and 78 conscious sedation. After matching, 36 patients remained in each group, with no significant difference in the measured safety or clinical outcomes. One major complication—acute visual loss caused by cerebral venous thrombosis—occurred in the conscious-sedation cohort.
Thirty-seven patients underwent same-admission venography and stenting, compared with 77 staged procedures. All 17 fulminant cases belonged to the same-admission group. Apparent differences in time to recurrent headache and visual symptoms were no longer significant after matching, but restenosis requiring repeat stenting remained more frequent after the same-admission strategy.
Interpretation
Conscious sedation appears technically feasible for venous sinus stenting in selected patients and could remove a barrier to outpatient care. The increased repeat-stenting signal after same-admission treatment may reflect the biological and clinical severity of fulminant disease, residual confounding or differences in pressure measurement and selection; it should not be attributed automatically to workflow.
Limitations
This was a retrospective single-center study with only 114 patients and one major complication, limiting safety comparisons. Anesthetic and admission strategies were chosen clinically rather than randomly. Propensity matching cannot correct unmeasured confounding, especially because every fulminant case entered the same-session group.
Clinical takeaway
Conscious sedation and staged outpatient venography followed by outpatient stenting may be reasonable in carefully selected, stable adults. Fulminant presentations still require expedited individualized treatment, and same-session stenting should not become routine until predictors of restenosis and the effect of anesthetic conditions on manometry are better defined.