scholarly journals Intracranial Venous Hypertension and Venous Sinus Stenting in the Modern Management of Idiopathic Intracranial Hypertension

Life ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 508
Author(s):  
Robert K. Townsend ◽  
Kyle M. Fargen
Keyword(s):  
Intracranial Hypertension ◽  
Young Women ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Hypertension ◽  
Venous Sinus ◽  
Venous Outflow ◽  
The Status ◽  
Insight Into ◽  
Symptom Recurrence

Idiopathic intracranial hypertension (IIH) is a debilitating condition that has traditionally been difficult to treat. In recent years, there has been increasing focus on the role of intracranial venous hypertension in the pathophysiology of IIH. Based on increased understanding of this pathophysiology, venous sinus stenting (VSS) has emerged as a safe and reliable treatment for a certain population of patients with IIH. Stratifying patients with IIH based on the status of their venous outflow can provide insight into which patients may enjoy reduction in their symptoms after VSS and provides information regarding why some patients may have symptom recurrence. The traditional view of IIH as a disease due to obesity in young women has been cast into doubt as the understanding of the role of intracranial venous hypertension has improved.

scholarly journals Exploring The Current Management Idiopathic Intracranial Hypertension, And Understanding The Role Of Dural Venous Sinus Stenting

Eye and Brain ◽  
2020 ◽  
Vol Volume 12 ◽  
pp. 1-13 ◽  
Author(s):  
Sam Gurney ◽  
Satheesh Ramalingam ◽  
Allan Thomas ◽  
Alexandra Sinclair ◽  
Susan Mollan
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Sinus ◽  
Current Management ◽  
Dural Venous Sinus

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 < .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.

Effect of Body Mass Index on Venous Sinus Pressures in Idiopathic Intracranial Hypertension Patients Before and After Endovascular Stenting

Neurosurgery ◽  
2017 ◽  
Vol 82 (4) ◽  
pp. 555-561 ◽  
Author(s):  
Daniel M S Raper ◽  
Dale Ding ◽  
Thomas J Buell ◽  
R Webster Crowley ◽  
Robert M Starke ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Pressure Gradient ◽  
Intracranial Hypertension ◽  
Body Mass ◽  
Idiopathic Intracranial Hypertension ◽  
Venous Pressure ◽  
Venous Hypertension ◽  
Venous Sinus ◽  
Morbidly Obese ◽  
Sinus Stenosis

Abstract BACKGROUND Elevated body mass index (BMI) has been correlated with worse outcomes after treatment for idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a safe and effective treatment for a subset of patients with IIH and evidence of venous sinus stenosis. However, the association between BMI and the efficacy of VSS remains poorly characterized. OBJECTIVE To determine, in a retrospective cohort study, the effect of BMI on preoperative mean intracranial venous pressure (MVP) and post-VSS outcomes. METHODS We performed a retrospective evaluation of a prospectively collected database of patients with IIH and intracranial venous sinus stenosis who underwent VSS. Patient demographics and treatment factors, including pre- and postprocedural trans-stenosis pressure gradients, were analyzed to identify the relationship between BMI and outcomes after VSS. RESULTS Increasing BMI was significantly correlated with higher maximum MVP (P = .013) and higher trans-stenosis pressure gradient (P = .043) prior to treatment. The degrees of improvement in maximum MVP and pressure gradient after VSS were greatest for obese and morbidly obese patients (BMI > 30 kg/m2). Maximum poststent MVP, clinical outcomes, and stent-adjacent stenosis requiring retreatment after VSS were not significantly associated with BMI. CONCLUSION We provide direct evidence for a positive correlation between BMI and intracranial venous pressure in patients with IIH. VSS affords a significantly greater amelioration of intracranial venous hypertension and stenosis for IIH patients with higher BMIs. As such, obesity should not be a deterrent for the use of VSS in the management of IIH.

Venous Sinus Pulsatility and the Potential Role of Dural Incompetence in Idiopathic Intracranial Hypertension

Neurosurgery ◽  
2012 ◽  
pp. 1
Author(s):  
Marc A. Lazzaro ◽  
Ziad Darkhabani ◽  
Bernd F. Remler ◽  
Sang H. Hong ◽  
Thomas J. Wolfe ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Potential Role ◽  
Venous Sinus

Venous Sinus Pulsatility and the Potential Role of Dural Incompetence in Idiopathic Intracranial Hypertension

Neurosurgery ◽  
2012 ◽  
Vol 71 (4) ◽  
pp. 877-884 ◽  
Author(s):  
Marc A. Lazzaro ◽  
Ziad Darkhabani ◽  
Bernd F. Remler ◽  
Sang H. Hong ◽  
Thomas J. Wolfe ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Intracranial Hypertension ◽  
Stent Implantation ◽  
Idiopathic Intracranial Hypertension ◽  
Potential Role ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Dural Sinus ◽  
Complete Understanding

Abstract BACKGROUND: Idiopathic intracranial hypertension (IIH) remains a poorly understood and therapeutically challenging disease. Enthusiasm has emerged for endovascular therapy with stent reconstruction of dural sinus narrowing; however, a complete understanding of the hydrodynamic dysequilibrium is lacking. OBJECTIVE: To review and characterize catheter manometry findings including pulsatility changes within the venous sinuses in IIH. METHODS: Cases of venous sinus stent implantation for IIH were retrospectively reviewed. RESULTS: Three cases of venous sinus stent implantation for treatment of IIH are reported. All cases demonstrated severe narrowing (>70%) within the transverse sinus and a high pressure gradient across the lesion (>30 mm Hg). Stent implantation resulted in pulsatility attenuation, correction of pressure gradient, and improvement of flow. CONCLUSION: We report the finding of high venous sinus pulsatility attenuation after stent implantation for dural sinus narrowing and propose the hypothesis that this finding is a marker of advanced dural sinus incompetence. This characteristic may be useful in identifying patients who would benefit from endovascular stent remodeling.

Prevalence of dural venous sinus stenosis and hypoplasia in a generalized population

2016 ◽  
Vol 8 (11) ◽  
pp. 1173-1177 ◽  
Author(s):  
Christopher R Durst ◽  
David A Ornan ◽  
Michael A Reardon ◽  
Prachi Mehndiratta ◽  
Sugoto Mukherjee ◽  
...  
Keyword(s):  
General Population ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Inclusion Criteria ◽  
Multivariate Statistical ◽  
Sinus Stenosis ◽  
Dural Venous Sinus

Background and purposeWhile recent literature has described the prevalence of transverse sinus stenosis in patients with idiopathic intracranial hypertension, tinnitus, and refractory headaches, it is unclear what the prevalence is in the general population. This study evaluates the prevalence of venous sinus stenosis and hypoplasia in the general patient population.Materials and methods355 of 600 consecutive patients who underwent CT angiography of the head met the inclusion criteria. The diameters of the dural venous sinuses were recorded. Each study was evaluated by a neuroradiologist for the presence of stenoses. Univariate and multivariate statistical analyses were performed by a statistician.ResultsThe prevalence of unilateral transverse sinus stenosis or hypoplasia in a sample of patients representing the general population was 33%, the prevalence of bilateral transverse sinus stenosis was 5%, and the prevalence of unilateral stenosis with contralateral hypoplasia was 1%. A multivariate analysis identified arachnoid granulations as a predictor of stenosis (p<0.001). Gender trended toward significance (p=0.094). Race was not a significant predictor of stenosis (p=0.745).ConclusionsThe prevalence of bilateral transverse sinus stenosis in the general population is not trivial. These data may be used as a reference for understanding the mechanistic role of stenoses in idiopathic intracranial hypertension, tinnitus, and refractory headaches.

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