Dural venous sinuses distortion and compression with supratentorial mass lesions: a mechanism for refractory intracranial hypertension?

Abstract

Objective—To determine the effect of supratentorial intraparenchymal mass lesions of various volumes
on dural venous sinuses structure and transluminal pressures.
Methods—Three set of preparations were made using adult isolated head derived from fresh human
cadaver. A supratentorial intraparenchymal balloon was introduced and inflated at various volumes and
effect on dural venous sinuses was assessed by serial intravascular ultrasound, computed tomographic
(CT), and magnetic resonance (MR) venograms. Contrast was injected through a catheter placed in sigmoid
sinus for both CT and MR venograms. Serial trasluminal pressures were measured from middle part of
superior sagittal sinus in another set of experiments.
Results—At intraparenchymal balloon inflation of 90 cm3
, there was attenuation of contrast enhancement
of superior sagittal sinus with compression visualized in posterior part of the sinus without any evidence of
compression in the remaining sinus. At intraparenchymal balloon inflation of 180 and 210 cm3
, there was
compression and obliteration of superior sagittal sinus throughout the length of the sinus. In the coronal
sections, at intraparenchymal balloon inflations of 90 and 120 cm3
, compression and obliteration of the
posterior part of superior sagittal sinus were visualized. In the axial images, basal veins were not visualized
with intraparenchymal balloon inflation of 90 cm3
or greater although straight sinus was visualized at all
levels of inflation. Trasluminal pressure in the middle part of superior sagittal sinus demonstrated a mild
increase from 0 cm H2O to 0.4 cm H2O and 0.5 cm H2O with inflation of balloon to volume of 150 and 180
cm3
, respectively. There was a rapid increase in transluminal pressure from 6.8 cm H2O to 25.6 cm H2O as
the supratentorial mass lesion increased from 180 to 200 cm3
.
Conclusions—Our experiments identified distortion and segmental and global obliteration of dural
venous sinuses secondary to supratentorial mass lesion and increase in transluminal pressure with large volume lesions. The secondary involvement of dural venous sinuses may represent a mechanism for refractory
intracranial hypertension.