Transient resolution of venous sinus stenosis after high-volume lumbar puncture in a patient with idiopathic intracranial hypertension

Thomas J. Buell Departments of Neurosurgery and

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Daniel M. S. Raper Departments of Neurosurgery and

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I. Jonathan Pomeraniec Departments of Neurosurgery and

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Dale Ding Departments of Neurosurgery and

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Ching-Jen Chen Departments of Neurosurgery and

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Davis G. Taylor Departments of Neurosurgery and

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Kenneth C. Liu Departments of Neurosurgery and
Radiology, University of Virginia Health System, Charlottesville, Virginia

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Stenosis of the transverse sinus (TS) and sigmoid sinus (SS), with a trans-stenosis pressure gradient, has been implicated in the pathophysiology of idiopathic intracranial hypertension (IIH). MRI has shown improvement in TS and SS stenosis after high-volume lumbar puncture (HVLP) in a subset of patients with IIH. The authors present the first report of an IIH patient with immediate post-HVLP TS and SS trans-stenosis pressure gradient reduction and an attendant increase in TS and SS cross-sectional area confirmed using intravascular ultrasonography (IVUS). Recurrence of the patient’s TS-SS stenosis coincided with elevated HVLP opening pressure, and venous sinus stent placement resulted in clinical improvement. This report suggests that TS and SS stenosis may be a downstream effect of elevated intracranial pressure in IIH, rather than its principal etiological mechanism. However, the authors hypothesize that endovascular stenting may obliterate a positive feedback loop involving trans-stenosis pressure gradients, and still benefit appropriately selected patients.

ABBREVIATIONS

BMI = body mass index; HVLP = high-volume lumbar puncture; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension; IVUS = intravascular ultrasonography; MVP = mean venous pressure; SS = sigmoid sinus; TS = transverse sinus.
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  • 1

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    Raper DM, Buell TJ, Ding D, Pomeraniec IJ, Crowley RW, Liu KC: A pilot study and novel angiographic classification for superior sagittal sinus stenting in patients with non-thrombotic intracranial venous occlusive disease. J Neurointerv Surg [epub ahead of print], 2017

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    Raper DM, Ding D, Chen CJ, Buell TJ, Crowley RW, Liu KC: Patency of the vein of Labbé after venous stenting of the transverse and sigmoid sinuses. J Neurointerv Surg [epub ahead of print], 2017

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