Intracranial venous sinus stenosis: hemodynamic assessment with two-dimensional parametric parenchymal blood flow software on digital subtraction angiography

2019 ◽  
Vol 12 (3) ◽  
pp. 311-314 ◽  
Author(s):  
Zayed Almadidy ◽  
Denise Brunozzi ◽  
Jessica Nelson ◽  
John Baumgart ◽  
Gursant Atwal ◽  
...  
Keyword(s):  
Blood Flow ◽  
Venous Sinus ◽  
Common Finding ◽  
Control Group ◽  
Two Dimensional ◽  
Stent Deployment ◽  
Venous Stenosis ◽  
Hemodynamic Assessment ◽  
Sinus Stenosis ◽  
Stenotic Vessel

ObjectiveIntracranial venous sinus stenosis (IVSS) is the most common finding associated with idiopathic intracranial hypertension. A pressure gradient >8–10 mm Hg across the stenosis is considered hemodynamically significant, and typically responds to endovascular stent treatment. Here we assess the venous hemodynamics with two-dimensional (2D) parametric parenchymal blood flow software (Siemens-Healthineers, Forchheim, Germany) and its ability to predict significant IVSS.MethodsPatients with IVSS treated at our institution between 2013 and 2018 were retrospectively reviewed. Measurements of contrast transit time on DSA were calculated with 2D parametric parenchymal blood flow software. Values were obtained proximally and distally to the stenotic region. Venous Stenosis Index (VSI) was defined as the ratio of the area under the curve (AUC) in the pre-stenotic vessel to the AUC in the post-stenotic vessel. VSI was compared between the stenotic and control groups at baseline, and before and after stent deployment in the stenotic group. The accuracy of VSI was assessed using the non-parametric receiver operating characteristic (ROC) curve.Results11 patients with IVSS treated with venous stent deployment were included. Patients in the control group were similar in age, gender, and absence of major comorbidities. VSI in the IVSS group was significantly higher at baseline compared with the control group (1.42 vs 0.97, p=0.01). Area under the ROC was 0.82. After stent deployment, VSI decreased significantly compared with baseline (1.04 vs 1.42, p<0.01).Conclusion2D parametric parenchymal blood flow software is a useful tool which can accurately evaluate significant hemodynamic venous stenosis without intracranial catheterization, added radiation exposure, additional contrast injection, and periprocedural risks.

scholarly journals Safely traversing venous sinus stenosis: The "Cobra" technique

2019 ◽  
Vol 26 (2) ◽  
pp. 231-234 ◽  
Author(s):  
Justin Schwarz ◽  
Alejandro Santillan ◽  
Athos Patsalides
Keyword(s):  
Minimally Invasive ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Sinus ◽  
Minimally Invasive Treatment ◽  
High Grade ◽  
Invasive Treatment ◽  
Inherent Difficulty ◽  
Venous Stenosis ◽  
Sinus Stenosis

Venous sinus stenting is an accepted and minimally invasive treatment for idiopathic intracranial hypertension associated with significant venous sinus stenosis. There is inherent difficulty in navigating past the region of venous stenosis in order to safely deliver and deploy a stent. We have developed the “Cobra” technique, which allows for the safe and efficient navigation past regions of high-grade venous sinus stenosis.

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

Neurosurgery ◽  
2019 ◽  
Vol 86 (5) ◽  
pp. 631-636 ◽  
Author(s):  
Mahmoud H Mohammaden ◽  
Muhammad Rizwan Husain ◽  
Denise Brunozzi ◽  
Ahmed E Hussein ◽  
Gursant Atwal ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Small Sample Size ◽  
Small Sample ◽  
Venous Sinus ◽  
Control Group ◽  
Multicenter Studies ◽  
Resistivity Index ◽  
Sinus Stenosis

Abstract BACKGROUND 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 &lt; .001) and TS (39.4 to 19.5, P &lt; .001), which was also associated with a significant reduction of the RI (0.22 vs 0.17, P &lt; .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.

Safety and efficacy of intravascular ultrasound as an adjunct to stenting for cerebral venous sinus stenosis–induced idiopathic intracranial hypertension: a pilot study

2020 ◽  
Vol 132 (3) ◽  
pp. 749-754 ◽  
Author(s):  
Feng Yan ◽  
Gary Rajah ◽  
Yuchuan Ding ◽  
Yang Hua ◽  
Hongqi Zhang ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Intravascular Ultrasound ◽  
Stent Placement ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Sinus ◽  
Wall Thickening ◽  
Venous Stenting ◽  
Venous Stenosis ◽  
Sinus Stenosis

OBJECTIVESymptomatic intracranial hypertension can be caused by cerebral venous sinus stenosis (CVSS) and cerebral venous sinus thrombotic (CVST) stenosis, which is usually found in some patients with idiopathic intracranial hypertension (IIH). Recently, at the authors’ center, they utilized intravascular ultrasound (IVUS) as an adjunct to conventional venoplasty or stenting to facilitate diagnosis and accurate stent placement in CVSS.METHODSThe authors designed a retrospective review of their prospective database of patients who underwent IVUS-guided venous sinus stenting between April 2016 and February 2017. Clinical, radiological, and ophthalmological information was recorded and analyzed. IVUS was performed in 12 patients with IIH (9 with nonthrombotic CVSS, 3 with secondary stenosis combined with CVST) during venoplasty through venous access. The IVUS catheter was used from a proximal location to the site of stenosis. Post-stenting follow-up, including symptomatic improvement, stent patency, and adjacent-site stenosis, was assessed at 1 year.RESULTSThirteen stenotic cerebral sinuses in 12 patients were corrected using IVUS-guided stenting. No technical or neurological complications were encountered. The IVUS images were excellent for the diagnosis of the stenosis, and intraluminal thrombi were clearly visualized by using IVUS in 3 (25%) of the 12 patients. A giant arachnoid granulation was demonstrated in 1 (8.3%) of the 12 patients. Intravenous compartments or septations (2 of 12, 16.7%) and vessel wall thickening (6 of 12, 50%) were also noted. At 1-year follow-up, 10 of 12 patients were clinically symptom-free in our series.CONCLUSIONSIVUS is a promising tool with the potential to improve the diagnostic accuracy in IIH, aiding in identification of the types of intracranial venous stenosis, assisting in stent selection, and guiding stent placement. Further study of the utility of IVUS in venous stenting and venous stenosis pathology is warranted.

Endovascular Treatment of Cerebral Venous Sinus Stenosis Based on Hemodynamic Assessment Using Pressure Wire

2020 ◽  
Vol 136 ◽  
pp. 323-325
Author(s):  
Rui Liu ◽  
Rui Sun ◽  
Feihong Huang ◽  
Yunfei Han ◽  
Ping Zheng ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Venous Sinus ◽  
Pressure Wire ◽  
Hemodynamic Assessment ◽  
Sinus Stenosis

Endoscopic Optic Nerve Sheath Fenestration for Treatment of Papilledema Secondary to Intracranial Venous Sinus Stenosis

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Wuttipong Tirakotai ◽  
Jiraporn Suwansanya ◽  
Ueaungkun Sitthimongkon ◽  
Patcharapim Masaya-Anon ◽  
Boonsam Roongpuvapaht
Keyword(s):  
Optic Nerve ◽  
Venous Sinus ◽  
Optic Nerve Sheath ◽  
Optic Nerve Sheath Fenestration ◽  
Nerve Sheath ◽  
Sinus Stenosis

Efficacy of Near-Infrared Spectrometry for Monitoring the Cerebral Effects of Severe Dilutional Anemia

2014 ◽  
Vol 17 (3) ◽  
pp. 154 ◽  
Author(s):  
Arıtürk Cem ◽  
Ustalar Serpil ◽  
Toraman Fevzi ◽  
Ökten Murat ◽  
Güllü Ümit ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Surgery ◽  
Blood Lactate ◽  
Near Infrared ◽  
Bypass Graft ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Infrared Spectrometry ◽  
Control Group ◽  
Near Infrared Spectrometry

<p><strong>Introduction:</strong> Clear guidelines for red cell transfusion during cardiac surgery have not yet been established. The current focus on blood conservation during cardiac surgery has increased the urgency to determine the minimum safe hematocrit for these patients. The aim of this study was to determine whether monitoring of cerebral regional oxygen saturation (rSO<sub>2</sub>) via near-infrared spectrometry (NIRS) is effective for assessing the cerebral effects of severe dilutional anemia during elective coronary arterial bypass graft surgery (CABG).</p><p><strong>Methods:</strong> The prospective observational study involved patients who underwent cerebral rSO<sub>2</sub> monitoring by NIRS during elective isolated first-time CABG: an anemic group (<em>N</em>=15) (minimum Hemoglobin (Hb) N=15) (Hb &gt;8 g/dL during CPB). Mean arterial pressure (MAP), pump blood flow, blood lactate level, pCO<sub>2</sub>, pO<sub>2</sub> at five time points and cross-clamp time, extracorporeal circulation time were recorded for each patient. Group results statistically were compared.</p><p><strong>Results:</strong> The anemic group had significantly lower mean preoperative Hb than the control group (10.3 mg/dL versus 14.2 mg/dL; <em>P</em> = .001). The lowest Hb levels were observed in the hypothermic period of CPB in the anemic group. None of the controls exhibited a &gt;20% decrease in cerebral rSO<sub>2</sub>. Eleven (73.3%) of the anemic patients required an increase in pump blood flow to raise their cerebral rSO<sub>2</sub>.</p><p><strong>Conclusions:</strong> In this study, the changes in cerebral rSO<sub>2</sub> in the patients with low Hb were within acceptable limits, and this was in concordance with the blood lactate levels and blood-gas analysis. It can be suggested that NIRS monitoring of cerebral rSO<sub>2</sub> can assist in decision making related to blood transfusion and dilutional anemia during CPB.</p>

EFFECT OF DRY IMMERSION ON BLOOD FLOW IN JUGULAR VEINS AND CEREBRAL VENOUS SINUS: ULTRASONIC METHODS OF INVESTIGATION

2018 ◽  
Vol 52 (2) ◽  
pp. 48-53
Author(s):  
T.I. Moreva ◽  
◽  
E.S. Kriushev ◽  
O.V. Moreva ◽  
O.B. Pasekova ◽  
...  
Keyword(s):  
Blood Flow ◽  
Venous Sinus ◽  
Jugular Veins ◽  
Ultrasonic Methods ◽  
Dry Immersion

scholarly journals Intracranial Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Case Report and Review of the Literature

2021 ◽  
Vol 11 (3) ◽  
pp. 382
Author(s):  
Dinesh Ramanathan ◽  
Zachary D. Travis ◽  
Emmanuel Omosor ◽  
Taylor Wilson ◽  
Nikhil Sahasrabudhe ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Subdural Hygroma ◽  
Presenting Symptoms ◽  
Minimal Improvement ◽  
Sinus Stenosis ◽  
Work Up

We describe a case of severe headaches, double vision, and progressive vision loss secondary to a ruptured intracranial cyst (IAC) in a 31-year-old woman with no relevant past medical history. The case is peculiar because drainage of the subdural hygroma led to a minimal improvement in vision with persistent elevated intracranial pressure (ICP). Further exploration revealed transverse sinus stenosis necessitating stenting. Evaluation post-stenting showed marked reduction of ICP and improvement in symptoms. This report underscores the importance of comprehensive work-up and suspicion of multiple underlying etiologies that may be crucial to complete resolution of presenting symptoms in some cases. We provide an overview of the clinical indications and evidence for venous sinus stenting in treating idiopathic intracranial hypertension (IIH).

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