scholarly journals Contralateral approach to transverse-sigmoid sinus stenting

2020 ◽  
Vol 26 (5) ◽  
pp. 658-663
Author(s):  
Weston Gordon ◽  
Michael Abraham
Keyword(s):  
Case Series ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Dural Sinus ◽  
Presenting Symptoms ◽  
Antegrade Approach ◽  
Alternative Approach ◽  
Mean Pressure ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

Introduction Endovascular dural venous sinus stenting (DVSS) has emerged as a safe and effective therapy for idiopathic intracranial hypertension (IIH) in patients with transverse-sinus stenosis associated with an elevated mean pressure gradient (MPG). The typical antegrade approach, jugular to sigmoid to transverse, is not always technically feasible due to the degree of stenosis and other anatomic factors. To this point, there has been no reported cases of contralateral DVSS. We describe four cases of DVSS from a contralateral transverse-sigmoid sinus approach. Methods We describe 4 patients presenting with symptoms of IIH between 2019 and 2020 who we treated with contralateral transverse-sigmoid sinus stenting. Cases were reviewed for clinical data including initial presenting symptoms, devices used, other attempted IIH treatments, and follow up symptoms. Results Four female patients were identified and treated under general endotracheal anesthesia. Stenoses measured 72%, 78%, 67%, and 70% with MPGs across the transverse-sigmoid sinus of 19, 16, 9 and 13 mmHg, respectively. Post-stenting MPGs were 1, 0, 1 and 1 mmHg, respectively. Three patients had complete resolution of symptoms and 1 had partial resolution. No complications occurred. Conclusions This case series demonstrates successful transverse-sigmoid sinus stenting from the contralateral dural sinus and provides an alternative approach to DVSS in patients with IIH.

Neonatal giant dural sinus ectasia: a multimodality imaging approach

2021 ◽  
Vol 14 (9) ◽  
pp. e242439
Author(s):  
Ralph Rommualdo Abareta Zuniega ◽  
Julian Alejandro Santos ◽  
Romelito Jose Galvan Galsim ◽  
Jonathan Saputil Elevazo
Keyword(s):  
Multimodality Imaging ◽  
Case Reports ◽  
Case Series ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Cardiac Insufficiency ◽  
Dural Sinus ◽  
Dural Sinuses ◽  
Sagittal Sinus ◽  
Dural Venous Sinus

Dural venous sinus ectasia is a rare anomaly characterised by the formation of a large vascular lake within the leaves of the dural sinuses, usually associated with thrombosis. These lesions can cause brain compression, cardiac insufficiency and disseminated intravascular coagulation, which may lead to poor prognosis. We present the case of a neonate who presented with an intracranial mass on prenatal ultrasound. Postnatal transcranial ultrasonography, cranial CT and cranial MRI demonstrated a large lesion predominantly occupying the dural sinus confluence, extending into the sagittal sinus, straight sinus and right transverse sinus. The left marginal sinus remains unfused and patent. Concomitant arteriovenous malformations were evident in the median interhemispheric fissure and the left Sylvian fissure. There are several published case reports and case series describing malformations of the dural sinuses in perinatal and neonatal patients in recent years, but this case is unique in that: (1) there is the presence of a vascular malformation concomitant to the dural sinus ectasia and (2) it highlights the importance of imaging in clinching the diagnosis of giant dural venous sinus ectasia, as it is often misdiagnosed as more common conditions such as extra-axial intracranial haemorrhage.

Venous stenting with concurrent intracranial pressure monitoring for the treatment of pseudotumor cerebri

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Dale Ding ◽  
Robert M. Starke ◽  
Christopher R. Durst ◽  
R. Webster Crowley ◽  
Kenneth C. Liu
Keyword(s):  
Intracranial Pressure ◽  
Pressure Gradient ◽  
Pseudotumor Cerebri ◽  
Transverse Sinus ◽  
Intracranial Pressure Monitoring ◽  
Dural Sinus ◽  
Pressure Monitoring ◽  
Venous Stenting ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

Increasing evidence supports dural venous sinus stenosis as the patho-etiology of pseudotumor cerebri (PTC) in a subset of affected patients. In this video, we demonstrate our technique for 1) diagnostic venous manometry to identify a flow-limiting stenosis of the transverse sinus in a PTC patient; and 2) successful treatment of the patient with venous stenting across the structural and physiological stricture in the dural sinus. The pressure gradient decreased from 20 mmHg pre-stent to 3 mmHg post-stent. In order to further quantify the effect of our intervention, concurrent intracranial pressure monitoring was performed.The video can be found here: http://youtu.be/auxRg17F8yI.

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).

scholarly journals Sigmoid Sinus Patency following Vestibular Schwannoma Resection via Retrosigmoid versus Translabyrinthine Approach

2020 ◽  
Author(s):  
Andrea Ziegler ◽  
Nadeem El-Kouri ◽  
Zaneta Dymon ◽  
David Serrano ◽  
Mariah Bashir ◽  
...  
Keyword(s):  
Acoustic Neuroma ◽  
Treatment Options ◽  
Middle Cranial Fossa ◽  
Sigmoid Sinus ◽  
Surgical Approaches ◽  
Stereotactic Radiation ◽  
Acoustic Neuromas ◽  
Significant Difference ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

Abstract Introduction The treatment options for acoustic neuromas are observation with serial imaging, stereotactic radiation, or surgical resection. The most common surgical approaches are the translabyrinthine (TL), the retrosigmoid (RS), and the middle cranial fossa. During the TL approach the sigmoid sinus is decompressed with bipolar cautery to allow greater medial exposure. It is unknown if this causes any long-term narrowing or thrombus of the sigmoid sinus. Methods We performed a retrospective review of patients who underwent acoustic neuroma resection to determine if patients undergoing a TL approach for acoustic neuroma resection develop radiographic evidence of sigmoid sinus stenosis or thrombosis compared with patients undergoing a RS approach. Results A total of 128 patients were included in this study, 56 patients underwent a TL approach and 72 patients underwent a RS approach. We compared the preoperative and postoperative diameter of the ipsilateral and contralateral sigmoid sinus at proximal, midpoint, and distal locations on magnetic resonance imaging examinations. There was no significant difference between the preoperative and postoperative diameter of the ipsilateral or contralateral sigmoid sinus based on surgical approach. Conclusion Decompression of the sigmoid sinus during the TL approach does not have a significant postoperative effect on the dural venous sinus patency.

Pattern and severity of transverse sinus stenosis in patients with pulsatile tinnitus associated with sigmoid sinus wall anomalies

2020 ◽  
Vol 130 (4) ◽  
pp. 1028-1033 ◽  
Author(s):  
Daniel Hewes ◽  
Robert Morales ◽  
Prashant Raghavan ◽  
David J. Eisenman
Keyword(s):  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Pulsatile Tinnitus ◽  
Sinus Wall ◽  
Sinus Stenosis

scholarly journals CT venography correlate of transverse sinus stenosis and venous transstenotic pressure gradient in unilateral pulsatile tinnitus patients with sigmoid sinus wall anomalies

2020 ◽  
Author(s):  
Pengfei Zhao ◽  
Heyu Ding ◽  
Han Lv ◽  
Xiaoshuai Li ◽  
Xiaoyu Qiu ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Transverse Sinus ◽  
Mean Value ◽  
Sigmoid Sinus ◽  
Pulsatile Tinnitus ◽  
Ct Venography ◽  
Sinus Wall ◽  
Key Points ◽  
Sinus Stenosis ◽  
Different Shapes

Abstract Objectives To investigate the correlation between transverse sinus stenosis (TSS) and transstenotic pressure gradient (TPG) in unilateral pulsatile tinnitus (PT) patients with sigmoid sinus wall anomalies (SSWA). Methods Fifty-seven patients with unilateral venous PT were retrospectively included. All of them underwent CT venography and catheter manometry, accompanied with SSWA. The degree, length, shape (intrinsic/extrinsic/dysplasia), location (proximal/middle/distal, referring to the relative position of TSS and the Labbé vein junction) of TSS, the types of SSWA (dehiscence/diverticulum), and the degree of transverse sinus outflow laterality were assessed, and the correlations with ipsilesional TPG were analyzed. Results The mean value of ipsilesional TPG was 7.61 ± 0.52 mmHg. The degree and length of ipsilesional TSS were positively correlated with TPG (p < 0.001, p’ < 0.001), respectively. TPG was significantly larger in patients with contralateral transverse sinus dysplasia than those without (p = 0.023) and significantly smaller in patients with ipsilesional sigmoid sinus diverticulum than those with isolated dehiscence (p = 0.001). No statistical difference in TPG was shown between ipsilesional TSSs of different shapes or locations (p > 0.05). No correlation was noted between the degree of ipsilesional transverse sinus outflow laterality and TPG (p = 0.051). Stepwise linear regression indicated that the degree (β = 9.207, 95% CI = 3.558–14.856), length (β = 0.122, 95% CI = 0.025–0.220) of ipsilesional TSS, and contralateral transverse sinus dysplasia (β = 1.875, 95% CI = 0.220–3.530) were significantly correlated with TPG (R2 = 0.471). Conclusions The degree, length of ipsilesional TSS, and contralateral transverse sinus dysplasia may be used to predict TPG in unilateral PT patients with SSWA. Key Points • CT venography may act as a screening tool to help low-probability unilateral pulsatile tinnitus (PT) patients with sigmoid sinus wall anomalies (SSWA) avoid invasive catheter manometry. • The degree and length of ipsilesional transverse sinus stenosis (TSS) are positively correlated with transtenotic pressure gradient (TPG) in unilateral PT patients with SSWA. • Ipsilesional TPG is larger in unilateral PT patients with contralateral transverse sinus dysplasia than those without and is smaller in unilateral PT patients with sigmoid sinus diverticulum than those with isolated dehiscence.

scholarly journals Oral contraceptive consumption and cerebral venous sinuses thrombosis

2016 ◽  
Vol 17 (1) ◽  
pp. 2-5
Author(s):  
Jha Gupta Kukum ◽  
Jha Rajiv
Keyword(s):  
Risk Factors ◽  
Oral Contraceptive ◽  
Sinus Thrombosis ◽  
Case Series ◽  
Venous Sinus ◽  
Dural Sinus ◽  
Retrospective Case ◽  
Venous Sinus Thrombosis ◽  
Presenting Symptoms ◽  
Neurologic Deficits

Introduction: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and the clinical presentation is variable. One of the more common acquired risk factors of venous sinus thrombosis is oral contraceptive medications. While the prognosis for CVST is favorable, it is important to identify and treat early to prevent neurologic deficits. CVST accounts for 0.5% of strokes and most commonly presents with headaches and in many cases focal neurologic deficits. Diagnosis is confirmed with neuroimaging including CT angiography or MR angiography. Treatment consists of anticoagulation and in some cases, thrombolytic therapy is beneficial. The overall prognosis of CVST is favorable.The objective of the study is to describe the features of a series of patient with CVST due to consumption of OCPs, treated in the department of Neurosurgery, Bir hospital and OM hospital, and to discuss the risk factors associated with consumption of OCPs, its presentation, and outcome.Methods: This is a retrospective case series carried out in the department of Neurosurgery, Bir hospital and OM hospital during the year September 2012 to September 2014. Demographic features like age, presenting symptoms, clinical findings and outcome were analyzed. All cases received heparin or LMWH followed by Warfarin.Results: Nine patients were identified over a period of 2 years. The presenting symptoms included headache, vomiting, loss of consciousness, focal neurological deficit, seizure and neck pain. Signs found included papilloedema, fever, slurring of speech and focal neurological signs.Conclusion: Dural sinus thrombosis is a rare and under-recognized cause of headache that should be considered in women with recent introduction of hormonal contraception. The absence of papilledema and a negative CT brain should not halt further workup. MRI/venogram is mandatory to confirm the diagnosis.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 2-5

Study on the correlation between hemodynamic status of the transverse sinus-sigmoid sinus and the clinical efficacy of sigmoid sinus wall reconstruction

2021 ◽  
pp. 159101992110620
Author(s):  
Zhenfeng Li ◽  
Long Jin
Keyword(s):  
Blood Flow ◽  
Pressure Distribution ◽  
Flow Velocity ◽  
Clinical Efficacy ◽  
Blood Flow Velocity ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Pulsatile Tinnitus ◽  
Sinus Wall ◽  
Sinus Stenosis

Background and Purpose For patients with pulsatile tinnitus who have both transverse sinus stenosis and sigmoid sinus wall anomalies, sigmoid sinus wall reconstruction surgery is the first-choice treatment when the trans-stenotic pressure gradient less than 10 mmHg. However, not all patients are cured by surgery. We hypothesized the abnormal hemodynamics caused by transverse sinus stenosis is associated with the clinical efficacy of surgery. Methods Eight pulsatile tinnitus patients treated with surgery were retrospectively reviewed (4 rehabilitated, 4 nonrehabilitated). All patients had radiologically diagnosed transverse sinus stenosis and sigmoid sinus wall anomalies. A numerical simulation of the hemodynamics of the transverse sinus-sigmoid sinus was performed using computational fluid dynamics technology. Changes in the blood flow patterns before and after surgery were observed. The blood flow velocity at the stenosis, vorticity of blood flow in the sigmoid sinus and wall pressure distribution in the sigmoid sinus wall anomalies area were compared. Results The blood flow velocity in the stenosis (preoperative P = 0.04, postoperative P = 0.004) and vorticity in the sigmoid sinus (preoperative P = 0.02, postoperative P = 0.007) pre- and post-surgery were significantly higher in the non-rehabilitation group than in the rehabilitation group. No significant difference was found in the wall pressure distribution in the sigmoid sinus wall anomalies area (preoperative P = 0.12, postoperative P = 0.24). Conclusions There is a clear correlation between the abnormal hemodynamic status caused by transverse sinus stenosis and the clinical efficacy of surgery. The blood flow velocity at the stenosis and vorticity of blood flow in the sigmoid sinus are factors influencing the clinical efficacy of surgery.

scholarly journals An Onyx tunnel: reconstructive transvenous balloon-assisted Onyx embolization for dural arteriovenous fistula of the transverse-sigmoid sinus

2018 ◽  
Vol 129 (4) ◽  
pp. 922-927 ◽  
Author(s):  
Mena G. Kerolus ◽  
Joonho Chung ◽  
Stephen A. Munich ◽  
Yoshikazu Matsuda ◽  
Hideo Okada ◽  
...  
Keyword(s):  
Treatment Option ◽  
Balloon Catheter ◽  
Transverse Sinus ◽  
Sigmoid Sinus ◽  
Dural Sinus ◽  
Effective Treatment Option ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Technical Details

Transvenous embolization is an effective method for treating dural arteriovenous fistulas (DAVFs) of the transverse-sigmoid sinus (TSS). However, in cases of complicated DAVFs, it is difficult to preserve the patency of the dural sinus. The authors describe the technical details of a new reconstructive technique using transvenous balloon-assisted Onyx embolization as another treatment option in a patient with an extensive and complex DAVF of the left TSS.A microcatheter and compliant balloon catheter were navigated into the left internal jugular vein and placed at the distal end of the DAVF in the transverse sinus. The microcatheter was placed between the vessel wall of the TSS and the balloon. After the balloon was fully inflated, Onyx-18 was injected at the periphery of the balloon in a slow, controlled, progressive, stepwise manner; the balloon and microcatheter were simultaneously withdrawn toward the sigmoid sinus, with Onyx encompassing the entirety of the complex DAVF. The Onyx refluxed into multiple arterial feeders in a distal-to-proximal step-by-step manner, ultimately resulting in an Onyx tunnel. The final angiography study revealed complete obliteration of the DAVF and patency of the TSS.The Onyx tunnel, or reconstructive transvenous balloon-assisted Onyx embolization technique, may be an effective treatment option for large, complex DAVFs of the TSS. This technique may provide another option to facilitate the complete obliteration of the DAVF while preserving the functional sinus.

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