Pressure variations in cerebral venous sinuses of idiopathic intracranial hypertension patients

Abstract

Purpose—To evaluate the alteration of pressure characteristics in the cerebral venous sinuses before and
after venous sinus stenting (VSS) using mean sinus pressures (MSPs), sinus pressure gradient (SPG), and
sinus pressure pulsatility (SPP) parameters among the idiopathic intracranial hypertension (IIH) patients.
Materials and Methods—Prospective evaluation of 45 consecutive IIH patients who underwent VSS at
our institution. A written informed consent approved by the Weill Cornell Institutional Review Board was
signed by the study participants. All patients (n = 45) were evaluated for MSPs and SPG. In a subgroup of
12 (n = 12) consecutive patients, SPP was measured. MSP was measured using microcatheter at superior
sagittal sinus (SSS), transverse sinus (TS), and sigmoid sinus (SS). SPG was measured as trans-stenotic
gradient and trans-torcular gradient. SPP was recorded in the dominant TS with a six French intermediate
catheter. Statistical analysis was performed using paired student t-test and two sample t-tests tested for both
equal and unequal variances. P values below 0.05 were considered significant.
Results—The mean age of the study population was 30.6 ± 10 years (7–59 years) and 43 out of 45 are
female patients. The mean weight and BMI of the study population were 96 ± 24.7 kg (30.8–144 kg) and
35.6 ± 8.3 kg/M2
(16.4–51.4 kg/M2
), respectively. VSS in IIH patients resulted in immediate reduction of
MSP in the SSS {Δ Mean: −8.1 mm Hg [95% confidence interval (CI): −5.0–11.7 mm Hg], p < 0.001} and
TS [Δ Mean: −11.8 mm Hg (95% CI: −7.5 to 13.4 mm Hg), p < 0.001] and increase of MSP in SS [Δ
Mean: 7.5 mm Hg (95% CI: 6–10.1 mm Hg), p < 0.001]. Significant reduction of trans-stenotic SPG reduction [Δ Mean: −15.7 mm Hg (95% CI: −13.6–17.8 mm Hg), p < 0.001] and SPP [Δ Mean: −8 mm Hg (95%
CI: −2.5–13.4 mm Hg), p < 0.05] was observed following VSS.
Conclusion—VSS resulted in immediate alteration of the cerebral venous sinus pressure measurements
in patients with IIH.