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

*Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin ‡Department of Ophthalmology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin §Clement Zablocki VA Medical Center, Milwaukee, Wisconsin ¶Arrowhead Neurosurgery, Desert Regional Medical Center, Palm Springs, California ‖Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin #Department of Radiology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin.
Neurosurgery (Impact Factor: 3.03). 10/2012; 71(4):877-884. DOI: 10.1227/NEU.0b013e318267a8f9
Source: PubMed

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. ABBREVIATIONS:: DSN, dural sinus narrowingDSV, digital subtraction venographyICP, intracranial pressureIIH, idiopathic intracranial hypertensionMRV, magnetic resonance venography.

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