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Schartz D, Finkelstein A, Akkipeddi SMK, Williams Z, Vates E, Bender MT. Outcomes of Pulsatile Tinnitus After Cerebral Venous Sinus Stenting: Systematic Review and Pooled Analysis of 616 Patients. World Neurosurg 2024:S1878-8750(24)01407-4. [PMID: 39142383 DOI: 10.1016/j.wneu.2024.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Pulsatile tinnitus (PT) is a debilitating condition with substantial morbidity related to quality of life. Cerebral venous sinus stenosis has recently emerged as a noninfrequent cause of PT, either in the setting of concurrent idiopathic intracranial hypertension (IIH) or due to primary venous stenosis. Venous sinus stenting (VSS) is an endovascular technique that can be used to treat venous stenosis. However, it is unclear if outcomes are different between patients with primary venogenic PT and IIH associated PT. METHODS A systematic literature review and pooled analysis was completed to evaluate the clinical outcomes of PT in patients undergoing cerebral VSS. Outcome measures included: Improved PT, complete resolution of PT, and PT recurrence at follow-up. Subgroup analysis between patients with IIH and primary PT was completed. RESULTS In total, 28 studies were identified with 616 patients. The proportion of improved PT symptoms after VSS had an overall pooled rate of 91.7% (confidence interval [CI]:88.1%-95.2%; I2 = 65%) and no difference between subgroups (P = 0.12). Complete resolution after VSS had an overall pooled rate of 88.6% (CI: 84.0%-93.3%; I2 = 68%) and no significant difference between subgroups (P = 0.35). Recurrent PT after stenting occurred in 6.5% of cases (CI: 1.7%-11.3%; I2 = 62%). Furthermore, subgroup analysis demonstrated that IIH patients had a significantly higher recurrence rate (10.6%; CI: 5.2%-16.1%; I2 = 26%) compared to patients treated with venous stenting for PT as the primary indication (2.0%; CI: 0.8%-4.7%; I2 = 0%) (P < 0.0001). CONCLUSIONS Venous stenting in patients with PT results in a substantial decrease and often complete resolution of symptoms. PT is more likely to recur in patients with IIH-associated PT.
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Affiliation(s)
- Derrek Schartz
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA.
| | - Alan Finkelstein
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Sajal Medha K Akkipeddi
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Zoe Williams
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York, USA
| | - Edward Vates
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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White TG, Chen A, Dalal S, Mehta SH, Turpin J, Papadimitriou K, Link T, Patsalides A. Treatment of tumor-induced cerebral venous sinus stenosis: Technical note and review of the literature. Interv Neuroradiol 2024:15910199241267341. [PMID: 39094581 DOI: 10.1177/15910199241267341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Tumors that invade or compress the venous sinuses have the potential to impair venous drainage. Rarely, this may be so severe as to induce intracranial hypertension. Other studies have previously described venous sinus stenting (VSS) for the treatment of these symptomatic lesions. In this report, we present our series of eight cases of VSS for symptomatic tumor-induced venous sinus stenosis and review the existing literature. CASES Eight patients with mostly intracranial tumors were found to have symptomatic venous sinus stenosis with the most common presenting symptom being elevated intracranial pressure. Six of the eight (75%) patients presented with papilledema on neuro-ophthalmological exam. The most affected locations were the transverse and sigmoid sinuses in four patients, followed by the superior sagittal sinus in three patients. All eight patients underwent VSS with no adverse events. In total, 6 out of 8 (75%) of patients had complete resolution of their symptoms, while the remaining patients experienced at least partial improvement. CONCLUSION Tumors that cause symptomatic venous sinus stenosis may be successfully managed with VSS to improve venous drainage. This may facilitate continued conservative management of meningiomas or allow for treatment with noninvasive means, such as stereotactic radiosurgery. Depending on the size of the target stenosis, balloon-mounted coronary stents may be a suitable option to treat these lesions.
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Affiliation(s)
- Timothy G White
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Adrian Chen
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Sidd Dalal
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
- Department of Neurology, North Shore University Hospital/Long Island Jewish Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Shyle H Mehta
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Justin Turpin
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Kyriakos Papadimitriou
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Thomas Link
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Athos Patsalides
- Department of Neurological Surgery, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Zhou C, Zhou Y, Liu L, Jiang H, Wei H, Zhou C, Ji X. Progress and recognition of idiopathic intracranial hypertension: A narrative review. CNS Neurosci Ther 2024; 30:e14895. [PMID: 39097911 PMCID: PMC11298205 DOI: 10.1111/cns.14895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/03/2024] [Accepted: 07/19/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) mainly affects obese young women, causing elevated intracranial pressure, headaches, and papilledema, risking vision loss and severe headaches. Despite weight loss as the primary treatment, the underlying mechanisms remain unclear. Recent research explores novel therapeutic targets. AIMS This review aimed to provide a comprehensive understanding of IIH's pathophysiology and clinical features to inform pathogenesis and improve treatment strategies. METHODS Recent publications on IIH were searched and summarized using PubMed, Web of Science, and MEDLINE. RESULTS The review highlights potential pathomechanisms and therapeutic advances in IIH. CONCLUSION IIH incidence is rising, with growing evidence linking it to metabolic and hormonal disturbances. Early diagnosis and treatment remain challenging.
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Affiliation(s)
- Chenxia Zhou
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Neurology and Intracranial Hypertension and Cerebral Venous Disease CenterNational Health Commission of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yifan Zhou
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain DisordersBeijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision Medicine, Capital Medical UniversityBeijingChina
| | - Lu Liu
- Department of NeurologyXuanwu Hospital, Capital Medical UniversityBeijingChina
- Neurology and Intracranial Hypertension and Cerebral Venous Disease CenterNational Health Commission of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
- Zhongguancun Xirui Institute of Precision Medicine for Heart and Brain TumorsBeijingChina
| | - Huimin Jiang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain DisordersBeijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision Medicine, Capital Medical UniversityBeijingChina
| | - Huimin Wei
- Beijing Advanced Innovation Center for Big Data‐Based Precision MedicineSchool of Biological Science and Medical Engineering, Beihang UniversityBeijingChina
| | - Chen Zhou
- Neurology and Intracranial Hypertension and Cerebral Venous Disease CenterNational Health Commission of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain DisordersBeijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision Medicine, Capital Medical UniversityBeijingChina
| | - Xunming Ji
- Neurology and Intracranial Hypertension and Cerebral Venous Disease CenterNational Health Commission of China, Xuanwu Hospital, Capital Medical UniversityBeijingChina
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain DisordersBeijing Institute of Brain Disorders, Beijing Advanced Innovation Center for Big Data‐based Precision Medicine, Capital Medical UniversityBeijingChina
- Department of NeurosurgeryXuanwu Hospital, Capital Medical UniversityBeijingChina
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Schartz D, Finkelstein A, Akkipeddi SMK, Kessler A, Williams Z, Vates E, Hauck EF, Fargen KM, Bender MT. Total brain volume is associated with severity of transverse sinus stenosis in idiopathic intracranial hypertension. J Neurointerv Surg 2024:jnis-2024-021938. [PMID: 38960700 DOI: 10.1136/jnis-2024-021938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a complex neurological condition characterized by symptoms of increased intracranial pressure of unclear etiology. While transverse sinus stenosis (TSS) is often present in patients with IIH, how and why it occurs remains unclear. METHODS IIH patients and a set of age-matched normal controls were identified from our single-center tertiary care institution from 2016 to 2024. Brain MRIs before treatment were computationally segmented and parcellated using FreeSurfer software. Extent of TSS on MR venograms was graded using the Farb scoring system. Relationship between normalized brain volume, normalized brain-to-CSF volume, and TSS was investigated. Multiple linear regression was conducted to investigate the association between continuous variables, accounting for the covariates body mass index, sex, and age. RESULTS In total, 84 IIH patients (mean age, 29.8 years; 87% female) and 15 normal controls (mean age, 28.1 years) were included. Overall, increasing/worsening TSS was found to be significantly associated with normalized total brain volume (p=0.018, R=0.179) and brain-to-CSF ratio volume (p=0.026, R=0.184). Additionally, there was a significant difference between controls and IIH patients with mild and severe stenosis regarding normalized total brain volume (ANCOVA, p=0.023) and brain-to-CSF ratio volume (ANCOVA, p=0.034). Likewise, IIH patients with severe TSS had a significantly higher brain-to-CSF volume compared with controls (p=0.038) and compared with IIH patients with mild TSS (p=0.038). CONCLUSIONS These findings suggest that total brain volume is associated with extent of TSS, which may reflect extramural venous compression due to enlarged brain and/or venous hypertension with associated cerebral congestion/swelling.
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Affiliation(s)
- Derrek Schartz
- Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Alan Finkelstein
- Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Alex Kessler
- Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Zoe Williams
- Ophthalmology, University of Rochester Medical Center, Rochester, New York, USA
| | - Edward Vates
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Erik F Hauck
- Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Kyle M Fargen
- Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Matthew T Bender
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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Guédon A, Arpaia F, Thépenier C, Eliezer M, Villas Boas Alves S, Saint-Maurice JP, Houdart E. Temporal bone remodeling is an indicator of transverse sinus stenosis on computed tomography. Diagn Interv Imaging 2024:S2211-5684(24)00136-0. [PMID: 38866665 DOI: 10.1016/j.diii.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE The purpose of this study was to identify potential association between transverse sinus stenosis (TSS) and temporal bone thinning downstream of TSS on computed tomography (CT). MATERIALS AND METHODS Clinical and radiological data of patients with venous pulsatile tinnitus due to TSS (TSS group) and treated with stenting from 2019 to 2022 were retrospectively collected. An age-matched control group of patients with venous or neutral pulsatile tinnitus (control group) was built. CT measurements of temporal bone thickness were performed at the level of transverse-sigmoid sinus junction (E1) and the occipitomastoid suture (E2). E1; E2 and E1/E2 ratios obtained in TSS and control groups were compared. RESULTS A total of 122 patients with venous pulsatile tinnitus were included. There were 56 patients with TSS (TSS group; 56 women; mean age, 35.5 ± 11.3 [standard deviation] years) and 66 patients without TSS (control group; 54 women; mean age, 37.7 ± 10.5 [standard deviation] years). E1 measurements and E1/E2 ratios on the symptomatic and dominant sides were significantly lower in the TSS group by comparison with the contralateral side of the same group (P < 0.05) and the ipsilateral side of the control group (P < 0.05). There were no differences in median E2 values between the TSS group (6.8 mm; range: 3.5-10.8 mm) and the control group (7.1 mm; range: 2.9-11.2 mm) (P = 0.098). E1 = 0 mm was found only in the TSS group. At receiver operating characteristic (ROC) analysis, an E1/E2 ratio threshold of 0.562 maximized the ability to predict presence of TSS. An E1/E2 ratio < 0.562 was predictive of symptomatic TSS with an accuracy of 74% (95% confidence interval: 65-82%). The AUC for the diagnosis of TSS was 0.807 (95% CI: 0.729-0.885). CONCLUSION Temporal bone thickness is significantly reduced downstream of the stenosis on the pulsatile tinnitus side and may be a good indicator of symptomatic TSS.
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Affiliation(s)
- Alexis Guédon
- Department of Neuroradiology, AP-HP Nord, Hôpital Lariboisière, 75010 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France; INSERM UMR-S 1140, 75006 Paris, France.
| | - Francesco Arpaia
- Department of Neuroradiology, AP-HP Nord, Hôpital Lariboisière, 75010 Paris, France
| | - Cédric Thépenier
- French Armed Forces Biomedical Research Institute (IRBA), 91220 Brétigny-sur-Orge, France; Institut Pasteur, 75015 Paris, France
| | - Michael Eliezer
- Department of Neuroradiology, AP-HP Nord, Hôpital Lariboisière, 75010 Paris, France
| | | | | | - Emmanuel Houdart
- Department of Neuroradiology, AP-HP Nord, Hôpital Lariboisière, 75010 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
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Raynald, Chen N, Yang H, Tong X, Sui B, Qu H, Dong K, Wang Y, Miao Z, Mo D. Intravascular ultrasound characteristics of different types of stenosis in idiopathic intracranial hypertension with venous sinus stenosis. J Neurointerv Surg 2024; 16:506-511. [PMID: 37355254 DOI: 10.1136/jnis-2023-020345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/04/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND In this study, we analyzed the characteristics of different stenosis types in idiopathic intracranial hypertension (IIH) patients with venous sinus stenosis (VSS) using intravascular ultrasound (IVUS). METHODS We retrospectively reviewed data from patients who underwent IVUS evaluation during venography or stenting procedures between January 2014 and February 2022. RESULTS Among the 80 patients with intrinsic lesions, 47 cases were identified, including 41 single lesions and 6 multiple lesions. Single lesions consisted of 36 cases of AG, 3 cases of brain herniation, and 2 cases of septation. Multiple intrinsic lesions were found in 6 patients, with AG observed in the transverse sinus and sigmoid sinus. IVUS features varied depending on the anatomical variations of intrinsic stenosis. Additionally, among the 33 cases of extrinsic stenosis, two types were observed: unilateral compression (22 cases) and bilateral compression (11 cases), primarily affecting the transverse sinus. CONCLUSION IVUS effectively differentiated intrinsic and extrinsic types of stenosis and identified intraluminal and mural components of intrinsic stenosis.
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Affiliation(s)
- Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Na Chen
- Department of Neurology, Beijing Daxing Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hongchao Yang
- Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Binbin Sui
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hui Qu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Kehui Dong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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7
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Jiang Z, Shao W, Li W. The "Wrinkle Sign" in Time-of-Flight Magnetic Resonance Venography is a Hallmark of Idiopathic Intracranial Hypertension. World Neurosurg 2024; 183:204-205. [PMID: 38143030 DOI: 10.1016/j.wneu.2023.12.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 12/26/2023]
Abstract
Idiopathic intracranial hypertension (IIH) is usually caused by sinus stenosis, which manifests in magnetic resonance venography (MRV) as occlusion or intraluminal webbing. We present the case of a 27-year-old patient with IIH, and time-of-flight (TOF) MRV only exhibited a rare "wrinkle sign," which was eventually proved to indicate sinus obstruction. The patient received venting and recovered. The TOF MRV provides a nonradioactive approach to identify IIH patients who potentially need intervention.
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Affiliation(s)
- Zhouyang Jiang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wenyu Shao
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wenyan Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
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8
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Rangwala SD, Johnson K, See AP, Smith ER, Orbach DB. Direct Transverse Sinus Puncture for Transvenous Coil Embolization of Vein of Galen Malformations: Innovating Existing Techniques. Oper Neurosurg (Hagerstown) 2023; 25:e352-e358. [PMID: 37819101 DOI: 10.1227/ons.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/21/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Vein of Galen malformations (VOGMs) are complex arteriovenous malformations in neonates and young children. Recent advances in endovascular interventions have drastically improved treatment and clinical outcomes in what was previously high-morbidity, high-mortality disease. The high-flow shunt pathophysiology in VOGMs can lead to dynamic changes in the malformation angioarchitecture, and over time patients can develop jugular bulb stenosis. In the setting of inaccessible transvenous access to the malformation for endovascular embolization in cases where transarterial embolization is inadequate, a combined surgical and endovascular technique must be used. We present the first successful modern-day application of direct puncture through transverse sinus for transvenous embolization of a VOGM. CLINICAL PRESENTATION We present 2 unique cases of complex VOGM malformations in patients who had previously undergone staged endovascular embolization for reduction of flow within the malformation. On follow-up, in both cases, there was development of severe sigmoid sinus and jugular bulb stenosis, increasing intracranial venous congestion and causing marked clinical deterioration. The stenosis prevented traditional transvenous access and treatment. We describe a direct puncture transverse sinus access using a burr hole approach for endovascular transvenous embolization in both cases with successful clinical outcomes. CONCLUSION Direct access using burr hole craniotomy to the transverse sinus for transvenous endovascular embolization is a safe approach in the setting of severe jugular bulb stenosis for treatment of VOGMs. This technique can be done efficiently to achieve complete flow elimination in the malformation, in cases where that is called for, without significant risks or complications related to the approach.
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Affiliation(s)
- Shivani D Rangwala
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Kristin Johnson
- Vascular Biology Program, Boston Children's Hospital, Boston , Massachusetts , USA
| | - Alfred P See
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
- Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Edward R Smith
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Darren B Orbach
- Neurointerventional Radiology, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
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9
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Taishaku A, Ohno T, Iwata T, Shibata H, Ishida M, Aihara N. Reversible Bilateral Transverse Sinus Occlusion Treated by Lumboperitoneal Shunt in Idiopathic Intracranial Hypertension: A Case Report. NMC Case Rep J 2023; 10:327-330. [PMID: 38125932 PMCID: PMC10730385 DOI: 10.2176/jns-nmc.2023-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/21/2023] [Indexed: 12/23/2023] Open
Abstract
We report a patient with idiopathic intracranial hypertension (IIH) with bilateral transverse sinus occlusion treated by a lumboperitoneal shunt. A 45-year-old woman presented with visual disturbance and chronic headache. Magnetic resonance (MR) venography and three-dimensional computed tomography angiography (3D-CTA) showed occlusion of both transverse sinuses. After the surgery, MR venography and 3D-CTA showed no blockages in both transverse sinuses. This phenomenon reveals that obstruction of the bilateral transverse sinus is a consequence of intracranial hypertension, not just a single cause. Since many patients have an obstruction or stenosis of the venous sinus, there are some reports of endovascular treatment. Sinus reconstruction is usually effective, but it is not effective in some cases. Reversal of sinus occlusion suggests that endovascular therapy for IIH is inadequate in some cases.
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Affiliation(s)
- Atsuhito Taishaku
- Department of Neurosurgery, Nagoya City University East Medical Center, Nagoya, Aichi, Japan
| | - Takayuki Ohno
- Department of Neurosurgery, Nagoya City University East Medical Center, Nagoya, Aichi, Japan
| | - Takashi Iwata
- Department of Neurosurgery, Nagoya City University East Medical Center, Nagoya, Aichi, Japan
| | - Hiromi Shibata
- Department of Neurosurgery, Nagoya City University East Medical Center, Nagoya, Aichi, Japan
| | - Motoki Ishida
- Department of Neurosurgery, Nagoya City University East Medical Center, Nagoya, Aichi, Japan
| | - Noritaka Aihara
- Department of Neurosurgery, Nagoya City University East Medical Center, Nagoya, Aichi, Japan
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10
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Jain V, Policeni B, Juliano AF, Adunka O, Agarwal M, Dubey P, Friedman ER, Gule-Monroe MK, Hagiwara M, Hunt CH, Lo BM, Oh ES, Rath TJ, Roberts JK, Schultz D, Taheri MR, Zander D, Burns J. ACR Appropriateness Criteria® Tinnitus: 2023 Update. J Am Coll Radiol 2023; 20:S574-S591. [PMID: 38040471 DOI: 10.1016/j.jacr.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Tinnitus is abnormal perception of sound and has many subtypes. Clinical evaluation, audiometry, and otoscopy should be performed before ordering any imaging, as the choice of imaging will depend on various factors. Type of tinnitus (pulsatile or nonpulsatile) and otoscopy findings of a vascular retrotympanic lesion are key determinants to guide the choice of imaging studies. High-resolution CT temporal bone is an excellent tool to detect glomus tumors, abnormal course of vessels, and some other abnormalities when a vascular retrotympanic lesion is seen on otoscopy. CTA or a combination of MR and MRA/MRV are used to evaluate arterial or venous abnormalities like dural arteriovenous fistula, arteriovenous malformation, carotid stenosis, dural sinus stenosis, and bony abnormalities like sigmoid sinus wall abnormalities in cases of pulsatile tinnitus without a vascular retrotympanic lesion. MR of the brain is excellent in detecting mass lesions such as vestibular schwannomas in cases of unilateral nonpulsatile tinnitus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio.
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Oliver Adunka
- The Ohio State University Wexner Medical Center, Columbus, Ohio; American Academy of Otolaryngology-Head and Neck Surgery
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Mari Hagiwara
- New York University Langone Medical Center, New York, New York
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Esther S Oh
- Johns Hopkins University School of Medicine, Baltimore, Maryland; American Geriatrics Society
| | | | - J Kirk Roberts
- Columbia University Medical Center, New York, New York; American Academy of Neurology
| | - David Schultz
- Evansville Primary Care, Evansville, Indiana; American Academy of Family Physicians
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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11
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Hsieh YL, Wang W. Case report: Novel transtemporal transverse sinus decompression surgery to alleviate transverse sinus stenosis in a pulsatile tinnitus patient with restricted bilateral venous outflow. Front Surg 2023; 10:1268829. [PMID: 37841818 PMCID: PMC10573303 DOI: 10.3389/fsurg.2023.1268829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Transverse sinus (TS) stenosis is common in individuals with venous pulsatile tinnitus (PT). While PT can be addressed by endoluminal or extraluminal methods, the former has shown promise in alleviating symptoms associated with increased intracranial pressure. This study explores the potential of extraluminal methods to alleviate TS stenosis and eliminate PT caused by sigmoid sinus diverticulum. A 31-year-old male patient presenting with left-sided PT, attributed to a large, pedunculated sigmoid sinus diverticulum along with severe ipsilateral TS stenosis and contralateral TS hypoplasia, underwent ipsilateral extraluminal TS decompression surgery following sigmoid sinus wall reconstruction under local anesthesia. Postoperative CT and MR angiography revealed a significant increase in the TS lumen from 0.269 to 0.42 cm2 (56.02%) 2 years after surgery. Cervical Doppler ultrasound demonstrated a 36.07% increase in ipsilateral outflow volume to 16.6 g/s and a 77.63% increase in contralateral outflow volume to 1.35 g/s. In conclusion, this pioneering study showcases the potential of transtemporal TS decompression surgery in creating space for adaptive expansion of the TS lumen. However, the procedure should be reserved for individuals with severely compromised venous return.
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Affiliation(s)
| | - Wuqing Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
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12
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Elsaid N, Razek A, Batouty NM, Elmokadem AH, Tawfik AM, Saied A. Combined Conduit Score in Contrast-Enhanced Magnetic Resonance Venography in Patients with Idiopathic Intracranial Hypertension : Neuro-interventionalists' vs. Radiologists' Assessment. Clin Neuroradiol 2023; 33:695-700. [PMID: 36799990 PMCID: PMC10450004 DOI: 10.1007/s00062-023-01263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Based on increased understanding of the idiopathic intracranial hypertension (IIH) pathophysiology, venous sinus stenting (VSS) has emerged as an effective treatment for patients with transverse sinus stenosis (TSS). The presence of a reliable TSS screening tool is warranted. The combined conduit score (CCS) is the most widely used score for evaluation of the cerebral sinovenous stenosis in contrast-enhanced magnetic resonance venography (CE-MRV). PURPOSE OF THE STUDY To evaluate the interobserver agreement between neuro-interventionalists and radiologists with respect to the CCS in evaluation of transverse sinus stenosis in patients with idiopathic intracranial hypertension using CE-MRV. METHODS A retrospective study was conducted on 26 consecutive patients diagnosed with IIH and underwent CE-MRV. The 2 neuro-interventionalists and 2 radiologists separately evaluated the cerebral venous sinuses using the CCS. RESULTS The mean CCS was significantly different between the neuro-interventionalists and radiologists (p < 0.001), higher for the radiologists. The inter-rater reliability was excellent (ICC = 0.954, 95% CI: 0.898-0.979) between the 2 neuro-interventionalists, good between the 2 radiologists (ICC = 0.805, 95% CI: 0.418-0.921), but was not acceptable between the neuro-interventionalists and the radiologists (ICC 0.47 95% CI:-2.2-0.782). CONCLUSION Despite the excellent agreement between the neuro-interventionists and the good agreement between the radiologists, there was no agreement between the neuro-interventionists and the radiologists. Our finding suggests that there is a gap between the 2 specialties but does not favor any of them. Factors related to the observers, the venous sinus system, the MRV or the CCS score may have resulted in this discrepancy. Automatic or semi-automatic feature extractions to produce quantifiable biomarkers for IIH are warranted. The clinical decisions should not depend only on strongly observer-dependent scores with training and/or experience-dependent influences.
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Affiliation(s)
- Nada Elsaid
- Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed Razek
- Department of Diagnostic and interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nihal M Batouty
- Department of Diagnostic and interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ali H Elmokadem
- Department of Diagnostic and interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed M Tawfik
- Department of Diagnostic and interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Saied
- Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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13
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Hadad S, Rangwala SD, Stout JN, Mut F, Orbach DB, Cebral JR, See AP. Understanding development of jugular bulb stenosis in vein of galen malformations: identifying metrics of complex flow dynamics in the cerebral venous vasculature of infants. Front Physiol 2023; 14:1113034. [PMID: 37275225 PMCID: PMC10236198 DOI: 10.3389/fphys.2023.1113034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/24/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction: Computational fluid dynamics (CFD) assess biological systems based on specific boundary conditions. We propose modeling more advanced hemodynamic metrics, such as core line length (CL) and critical points which characterize complexity of flow in the context of cerebral vasculature, and specifically cerebral veins during the physiologically evolving early neonatal state of vein of Galen malformations (VOGM). CFD has not been applied to the study of arteriovenous shunting in Vein of Galen Malformations but could help illustrate the pathophysiology of this malformation. Methods: Three neonatal patients with VOGM at Boston Children's Hospital met inclusion criteria for this study. Structural MRI data was segmented to generate a mesh of the VOGM and venous outflow. Boundary condition flow velocity was derived from PC-MR sequences with arterial and venous dual velocity encoding. The mesh and boundary conditions were applied to model the cerebral venous flow. We computed flow variables including mean wall shear stress (WSSmean), mean OSI, CL, and the mean number of critical points (nCrPointsmean) for each patient specific model. A critical point is defined as the location where the shear stress vector field is zero (stationary point) and can be used to describe complexity of flow. Results: The division of flow into the left and right venous outflow was comparable between PC-MR and CFD modeling. A high complexity recirculating flow pattern observed on PC-MR was also identified on CFD modeling. Regions of similar WSSmean and OSImean (<1.3 fold) in the left and right venous outflow channels of a single patient have several-fold magnitude difference in higher order hemodynamic metrics (> 3.3 fold CL, > 1.7 fold nCrPointsmean). Specifically, the side which developed JBS in each model had greater nCrPointsmean compared to the jugular bulb with no stenosis (VOGM1: 4.49 vs. 2.53, VOGM2: 1.94 vs. 0, VOGM3: 1 vs. 0). Biologically, these regions had subsequently divergent development, with increased complexity of flow associating with venous stenosis. Discussion: Advanced metrics of flow complexity identified in computational models may reflect observed flow phenomena not fully characterized by primary or secondary hemodynamic parameters. These advanced metrics may indicate physiological states that impact development of jugular bulb stenosis in VOGM.
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Affiliation(s)
- Sara Hadad
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - Shivani D. Rangwala
- Cerebrovascular Surgery and Interventions Center, Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Neurosurgery, University of Southern California LAC+USC, Los Angeles, CA, United States
| | - Jeffrey N. Stout
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, United States
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - Darren B. Orbach
- Cerebrovascular Surgery and Interventions Center, Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, United States
- Neurointerventional Radiology, Boston Children’s Hospital, Boston, MA, United States
| | - Juan R. Cebral
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - Alfred P. See
- Cerebrovascular Surgery and Interventions Center, Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, United States
- Neurointerventional Radiology, Boston Children’s Hospital, Boston, MA, United States
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Bauschard MJ, Reichl K, Socolovsky LD, Sismanis AA, Coelho DH. Dural Venous Sinus Arachnoid Granulations in Patients with Pulsatile Tinnitus. Otol Neurotol 2022; 43:e787-e790. [PMID: 35878644 DOI: 10.1097/mao.0000000000003587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the relationship, if any, between dural venous sinus arachnoid granulations (AGs) and pulsatile tinnitus. STUDY DESIGN Retrospective case-control study. METHODS Between October 1999 and March 2020, magnetic resonance imaging of patients with tinnitus (pulsatile [PT] and nonpulsatile [NPT]) were assessed for the presence of dural venous sinuses AG. During the same interval, patients with AGs found incidentally on all magnetic resonance imagings ordered without an indication of tinnitus were reviewed. Demographic variables recorded included patient age, sex, race, body mass index, and a history of idiopathic intracranial hypertension (IIH) or obstructive sleep apnea. Location of AGs, when present, were recorded. RESULTS A total of 651 (PT 250, NPT 401) were found to have AGs. AGs had a higher prevalence in PT patients (10.4% [n = 26]) versus NPT patients (0.3% [n = 1]; odds ratio, 31.0; confidence interval 4.1-234; p < 0.001). Of the 77,607 patients who had an indication for imaging other than tinnitus, 230 patients (0.30%) were found to have incidental AGs, suggesting that the NPT cohort was an adequate control. Patients with PT were more likely to have a higher body mass index, be female, be non-White, and have an existing diagnosis of IIH. For all patients with AGs, AGs were more likely to be found in the lateral sinuses (i.e., sigmoid, transverse) in the PT group (odds ratio, 8.1; confidence interval, 1.1-61.1; p = 0.0218). CONCLUSIONS This study evaluates the association between AG and PT, finding higher rates of AG in patients with PT than in NPT. However, despite the increased prevalence of AG in patients with IIH, these data combined with existing literature would suggest that AGs are not necessarily the missing link to explain PT pathophysiology in IIH.
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Affiliation(s)
- Michael J Bauschard
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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15
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Zhao K, Gu W, Liu C, Kong D, Zheng C, Chen W, Li X, Liang Y, Zhou H. Advances in the Understanding of the Complex Role of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension. J Magn Reson Imaging 2022; 56:645-654. [PMID: 35357056 PMCID: PMC9541264 DOI: 10.1002/jmri.28177] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated intracranial pressure (ICP) that predominantly affects young obese women. IIH is a diagnosis of exclusion. That is, if increased ICP is suspected, magnetic resonance imaging and magnetic resonance venography of the brain are recommended to exclude secondary causes. Imaging findings, such as empty sella, orbital findings, meningocele, and encephalocele, are not diagnostic of ICP, nor does their absence exclude ICP either. Therefore, venous manometry is recommended as the gold standard for evaluation, regardless of previous anatomic imaging results. Venous manometry is an invasive examination that is frequently applied to derive physiologic information concerning the nature of the pressure gradient. However, the pathogenesis of IIH has not been fully elucidated. The presence of venous sinus stenosis in a subset of patients has provided some support for the potential mechanisms underlying this condition. Hence, this review provides an up‐to‐date discussion on the potential pathogenic mechanisms of IIH with a special focus on venous sinus stenosis.
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Affiliation(s)
- Kexin Zhao
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Wenjing Gu
- Department of Otorlaryngology, The First Hospital of Jilin University, Changchun, China
| | - Chunmei Liu
- Department of Gynecology, Changchun Obstetrics Gynecology Hospital, Changchun, China
| | - Derui Kong
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Chong Zheng
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Wei Chen
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Xuewei Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Yuchen Liang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Hongwei Zhou
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
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16
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Characteristics and Outcomes of the Idiopathic Intracranial Hypertension Treatment in Intrinsic and Extrinsic Stenosis: A Single-Center Experience in China. Neurol Ther 2021; 10:1029-1044. [PMID: 34542867 PMCID: PMC8571462 DOI: 10.1007/s40120-021-00281-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/03/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION This study aimed to explore the precipitating factors and evaluate the impact of different stenosis types on treatment outcomes in patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS). METHODS We recruited patients with IIH who presented with VSS, either intrinsic or extrinsic. We observed the clinical and laboratory findings, and we then compared the outcomes of stenting and medical treatment in different stenosis types. RESULTS Among 145 patients with IIH and VSS, 59 were of the intrinsic type and 86 were of the extrinsic type. Patients in the intrinsic group were older (42 vs. 34 years old, P < 0.001) and presented with higher pre-op gradient pressure (15 mmHg vs. 12 mmHg, P < 0.001). There was no significant difference between groups regarding other precipitating factors (P > 0.05). Stenting was significantly associated with complete resolution of the headache and impaired vision both in intrinsic (adjusted OR 0.017, 95% CI 0.001-0.35, P = 0.011; adjusted OR 0.056, 95% CI 0.004-0.697, P = 0.025, respectively) and extrinsic types of stenosis (adjusted OR 0.072, 95% CI 0.015-0.343, P = 0.001; adjusted OR 0.241, 95% CI 0.062-0.931, P = 0.039, respectively). Meanwhile, stenting was significantly associated with improvement of the papilledema in extrinsic-type stenosis compared with medical treatment (adjusted OR 0.017, 95% CI 0.002-0.135, P < 0.001). CONCLUSION Stenting may provide substantial clinical improvement in patients with IIH regardless of intrinsic or extrinsic stenosis type in our patient population, as noted in other series. TRIAL REGISTRATION Clinical trial registration number ChiCTR-ONN-17010421.
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17
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Gupta G, Rallo MS, Goldrich DY, Narayan V, Majmundar N, Roychowdhury S, Nanda A, Wackym PA. Management of Jugular Bulb Stenosis in Pediatric Vein of Galen Malformation: A Novel Management Paradigm. Pediatr Neurosurg 2021; 56:584-590. [PMID: 34614493 DOI: 10.1159/000517653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pediatric vein of Galen malformations (VOGMs) are fistulous intracranial malformations arising congenitally within the choroidal fissure that can present with an array of neurological and cardiac sequelae. Associated venous stenosis may result in intracranial venous hypertension and ischemia leading to severe, irreversible cerebral injury. Management of neonatal VOGMs typically involves staged embolization and angioplasty/stenting for relief of venous stenosis. Rarely, jugular foraminal narrowing has been identified as causing jugular bulb stenosis. CASE PRESENTATION We present the case of a 22-month-old female diagnosed with VOGM prenatally who displayed persistent intracranial venous hypertension despite multiple neuroembolization procedures during the neonatal period. Following initial reduction in arteriovenous shunting, she once again developed venous hypertension secondary to jugular bulb stenosis for which angioplasty was attempted. Failure of angioplasty to relieve the venous hypertension prompted skull base imaging, which revealed jugular foraminal ossification and stenosis. Microsurgical jugular foraminotomy followed by balloon angioplasty and stenting significantly reduced jugular pressure gradients. Restenosis requiring re-stenting developed postoperatively at 9 months, but the patient has remained stable with significant improvement in cortical venous congestion. DISCUSSION/CONCLUSION This case demonstrates the efficacy of microsurgical decompression of the jugular foramen and endovascular angioplasty/stenting as a novel treatment paradigm for the management of intracranial venous hypertension in the setting of VOGM.
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Affiliation(s)
- Gaurav Gupta
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michael S Rallo
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - David Y Goldrich
- Division of Otology and Neurotologic Skull Base Surgery, Department of Otolaryngology, Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Vinayak Narayan
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Neil Majmundar
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sudipta Roychowdhury
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Department of Radiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Anil Nanda
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - P Ashley Wackym
- Division of Otology and Neurotologic Skull Base Surgery, Department of Otolaryngology, Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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18
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Lenck S, Nicholson P. Cerebral Venous Wall Diseases: The Other Side of the Picture. AJNR Am J Neuroradiol 2021; 42:297-298. [PMID: 33414232 DOI: 10.3174/ajnr.a6914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- S Lenck
- Department of NeuroradiologyGroupe Hospitalier Pitié SalpêtrièreParis, France
- Groupe de Recherche Clinique (GRC) 31 E-HTICSorbonne UniversitéParis, France
| | - P Nicholson
- Department of NeuroradiologyToronto Western HospitalToronto, Canada
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