J Neurosurg 143:543–549, 2025
• Venous sinus stenosis (VSS) may cause raised intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH) via impaired venous outflow.
• This study identified predictors of elevated cerebral venous pressure gradient (CVPG) in IIH patients using venous manometry (VM).
• Key predictors of elevated CVPG include: childbearing age, African American race, obesity (BMI ≥ 30), papilledema, pulsatile tinnitus, focal VSS with unilateral dominance on MRV, and opening pressure on lumbar puncture (LP) ≥ 25 cm H₂O.
• Papilledema and pulsatile tinnitus showed the highest sensitivity and specificity among symptoms for predicting elevated CVPG.
• MRV is a useful noninvasive screening tool for VSS, but confirmation by VM is needed.
• An LP opening pressure ≥ 25 cm H₂O is an optimal threshold to refer IIH patients for VM.
• Obesity and younger age are strongly associated with elevated CVPG.
• Venous sinus stenting is a promising therapy for medically refractory IIH with elevated CVPG.
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