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

Thomas J. Buell, Daniel M.S. Raper, I. Jonathan Pomeraniec, Dale Ding, Ching Jen Chen, Davis G. Taylor, Kenneth C. Liu

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)153-156
Number of pages4
JournalJournal of neurosurgery
Volume129
Issue number1
DOIs
StatePublished - Jul 2018

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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