Resolution of venous pressure gradient in a patient with idiopathic intracranial hypertension after ventriculoperitoneal shunt placement: A proof of secondary cerebral sinovenous stenosis

Thomas Buell, Dale Ding, Daniel Raper, Ching Jen Chen, Zaid Aljuboori, Davis Taylor, Tony Wang, Natasha Ironside, Robert Starke, Kenneth Liu

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The relationship between idiopathic intracranial hypertension (IIH) and cerebral sinovenous stenosis (CSS) remains unclear. The effects of cerebrospinal fluid (CSF) diversion on venous sinus physiology have not been rigorously investigated. We describe the effect of ventriculoperitoneal shunt (VPS) placement on sinovenous pressures in the setting of IIH and CSS. Case Description: A patient in their 30 s presented with headache and transient visual obscurations for few months and was diagnosed with IIH. Catheter cerebral venography showed focal stenosis of the right transverse sinus (TS) with a trans-stenosis pressure gradient (TSG) of 20 mmHg. The patient was treated with VPS. During the procedure, we performed a real-time measurement of ventricular CSF and cerebral sinovenous pressures. VPS selectively reduced the TS pressure and abolished the preoperative TS-TSG within 20 min of CSF diversion without altering the sigmoid sinus (SS) pressure. Our findings suggest that CSS can be an epiphenomenon, rather than the primary etiology in some patients with IIH. Conclusion: IIH is a challenging condition, in certain patients the radiographic stenosis and trans-stenosis gradient were an epiphenomenon because of the increased intracranial pressure that resulted in reversible TS-SS stenosis.

Original languageEnglish (US)
Article numberSNI_700_2020
JournalSurgical Neurology International
Volume12
DOIs
StatePublished - Jan 2021

Keywords

  • Headache
  • Idiopathic intracranial hypertension
  • Venous sinus stenosis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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