Tag: Venous sinus stenosis

Posted on

Predictors of dural venous sinus pressure gradient in patients with idiopathic intracranial hypertension

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.

Posted on

Stenting for Venous Sinus Stenosis in Patients With Idiopathic Intracranial Hypertension

Neurosurgery 94:648–656, 2024

Although venous sinus stenting (VSS) improves cerebrospinal fluid reabsorption and decreases intracranial pressure in patients with idiopathic intracranial hypertension (IIH), the underlying pathophysiology of IIH is not well understood. We present a review and meta-analysis of the literature on VSS for IIH treatment, focusing on the rates of restenosis and symptom recurrence.

METHODS: We performed a systematic review of PubMed and Embase databases between January 1, 2011, and December 31, 2021. Articles including ≥5 patients with IIH and venous sinus stenosis treated with VSS and posttreatment rates of restenosis (de novo stenosis at a different anatomic location along the dural sinuses or restenosis within or adjacent to the stent) were selected. Demographic, procedural, and outcomes data were collected and analyzed. Mean values for variables collected were pooled, and a mean value was calculated with a 95% CI.

RESULTS: Twenty-four articles were included, comprising 694 patients and 781 VSS cases. The mean age was 33.9 (CI, 31.5-36.2) years. The mean body mass index was 35.3 (CI, 32.9-37.7) kg/m2 . Before VSS, 98.8% (CI, 96.8%-100.0%) of patients experienced headaches, 87.7% (CI, 80.6%-95.5%) had visual acuity issues, 78.7% (CI, 69.9%-88.5%) had papilledema, 58.3% (CI, 46.0%-73.9%) had tinnitus, and 98.8% (96.4%-100.0%) had symptoms refractory to previous therapies. After VSS, 77.7% (CI, 71.1%-84.95%) experienced symptom improvement and 22.3% (CI, 15.1%-29.0%) had persistent or worsened symptoms. Pooled restenosis rate was 17.7% (CI, 14.9%-20.9%).

CONCLUSION: VSS is effective in alleviating IIH signs and symptoms, but the associated high rates of restenosis and persistent symptoms highlight the need for further investigation of this procedure and other adjunctive treatments for IIH.

Posted on

Subacute vision loss after microvascular decompression for trigeminal neuralgia

Acta Neurochirurgica (2021) 163:1635–1638

Microvascular decompression is the surgery of choice for typical trigeminal neuralgia (TN) that fails conservative medical management. Visual loss after MVD is a rare complication that has not been reported.

In this article, we present a patient who developed delayed visual loss and papilledema from transverse sinus stenosis resulting from bone wax compression after MVD for TN.

While waxing the edges of a retrosigmoid craniotomy may seem mundane, meticulous care should be taken to ensure that there is no compression of the venous sinuses, as this could lead to intracranial hypertension.

Posted on

Role of Resistivity Index Analysis in the Prediction of Hemodynamically Significant Venous Sinus Stenosis in Patients With Idiopathic Intracranial Hypertension

Neurosurgery 86:631–636, 2020

The resistivity index (RI) in cerebral venous sinus stenosis (VSS) has not been studied in patients with idiopathic intracranial hypertension (IIH).

OBJECTIVE: To evaluate the role of RI measured by quantitative magnetic resonance venogram (QMRV) as a noninvasive tool in the diagnosis of venous hypertension associated with VSS in IIH.

METHODS:Retrospective evaluation of 13 consecutive IIH patients who underwent venous sinus stenting at our institution between 2013 and 2018. Patients’demographics, clinical presentation, cerebral mean venous sinus pressure (MVP), and RI both pre- and poststenting were recorded. The baseline RI was also compared to a control group.

RESULTS: Among 13 patients of IIH, 11 had unilateral VSS in dominant sinus, whereas 2 had bilateral VSS. RI was significantly higher in IIH patients compared to the control group in the superior sagittal (SSS) and transverse sinuses (TS) (0.21 vs 0.11, P=.01 and 0.22 vs 0.13, P=.03, respectively). The MVP (in mm Hg) decreased significantly after venous sinus stenting in the SSS (41.9 to 22.5, P < .001) and TS (39.4 to 19.5, P < .001), which was also associated with a significant reduction of the RI (0.22 vs 0.17, P < .01 in SSS and 0.23 vs 0.17, P = .03 in TS) poststenting.

CONCLUSION: RI calculated using QMRV can serve as a noninvasive tool to aid in the diagnosis of hemodynamically significant VSS. The study had a small sample size, and larger multicenter studies would be required to validate the results further.

Proudly powered by WordPress