Percutaneous endovascular biopsy in the diagnosis of venous sinus lesions: technical note

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Intracranial hypertension (IH) may be misdiagnosed owing to the lack of typical imaging features and pathological confirmation of the sinus lesions. The authors report the use of percutaneous endovascular biopsy (PEB) for the diagnosis of IH in patients with venous sinus lesions. A total of 9 patients (age 46 ± 9 years) underwent PEB between June 2016 and August 2017. All patients underwent lumbar puncture and contrast-enhanced MRI before the procedure. PEB was technically successful in 6 patients. No intra- or postprocedural complications occurred. The confirmed lesions were meningioma in 2 patients and fibrous thrombus in 4 patients. All patients received individualized treatment. PEB of venous sinus lesions is a safe and efficient method to establish an early diagnosis and appropriate treatment in patients with IH.

ABBREVIATIONS DAVF = dural arteriovenous fistula; ICP = intracranial pressure; IH = intracranial hypertension; IIH = idiopathic IH; PEB = percutaneous endovascular biopsy; MRBTI = magnetic resonance black-blood thrombus imaging; MRV = magnetic resonance venography.

Article Information

Correspondence Sheng Guan: The First Affiliated Hospital of Zhengzhou University, Henan, China. gsradio@126.com.

INCLUDE WHEN CITING Published online August 24, 2018; DOI: 10.3171/2018.3.JNS173143.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. A and B: Enhanced MR images demonstrating the lesion (white arrows) located in the left jugular foramen. C and D:  Angiographic images demonstrating occlusion of the left sigmoid sinus and the collateral veins. E: Image of a 2.3-mm biopsy forceps device used to obtain a specimen. F: Pathological analysis of the biopsy specimen revealed meningioma (H & E; magnification ×400).

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    Case 2. MRV (A) and angiogram (C) showing right transverse sinus stenosis, enhanced MR image (B) showing the lesion (white arrow), and angiogram obtained after stenting (G). A 1.8-mm biopsy forceps device (D) was used to obtain a specimen (E and F), for which pathological analysis revealed a fibrous thrombus (H & E; magnification ×400) (H).

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