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.
Keywords: BMI = body mass index; HVLP = high-volume lumbar puncture; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension; IVUS = intravascular ultrasonography; MVP = mean venous pressure; SS = sigmoid sinus; TS = transverse sinus; diagnostic technique; idiopathic intracranial hypertension; intracranial venous sinus; intravascular ultrasonography; stenosis; venous manometry.