Elsevier

World Neurosurgery

Volume 136, April 2020, Pages 323-325
World Neurosurgery

Case Report
Endovascular Treatment of Cerebral Venous Sinus Stenosis Based on Hemodynamic Assessment Using Pressure Wire

https://doi.org/10.1016/j.wneu.2020.01.128Get rights and content

Background

A pressure wire offers a dynamic tool to assist in the measurement of the pressure gradient and assessment of the functional significance of stenosis. The author presents a patient with idiopathic intracranial hypertension who was diagnosed with cerebral venous sinus stenosis (CVSS). Venography accompanied by pressure measurement was used to guide the stent placement for CVSS.

Case Description

A 27-year-old woman was referred to our hospital with a chief complaint of headache and neckache lasting for 7 weeks, with an 8-day history of binocular diplopia and blurred vision. Magnetic resonance venography and digital subtraction angiography showed a filling defect in the right transverse sinus. A pressure wire was used before endovascular treatment and showed that the pressure gradient was 10 mm Hg, which meets the surgical indication. After a stent was placed, no pressure gradient was recorded by the pressure wire.

Conclusions

This is the first report about using a pressure wire for CVSS. The finding suggests that use of a pressure wire can be a new approach in the diagnosis and treatment of CVSS.

Introduction

Idiopathic intracranial hypertension is mostly caused by increased cerebral venous pressure, and recently, interest has developed in the stenosis of intracranial venous sinuses.1,2 Restoring the patency of cerebral venous pressure gradient (CVSS) with stent placement can normalize intracranial pressure and significantly improve associated symptoms.3 Here, we report a case of CVSS that was successfully treated via endovascular treatment (EVT) based on hemodynamic assessment with a pressure wire.

Section snippets

Case Description

A 27-year-old woman was referred to our hospital with a chief complaint of headache and neckache for 7 weeks, with an 8-day history of binocular diplopia and blurred vision. She had a 10-year history of systemic lupus erythematosus, taking 17.5 mg of prednisone daily for a long period, and no history of migraine. On examination, both eyes were incapable of outward movements. Her pupillary light reflex was normal. Funduscopic examination revealed that the border of the left optic nerve head was

Discussion

We present a case of CVSS, which was successfully treated via EVT based on a hemodynamic assessment using a pressure wire. To the best of our knowledge, this is the first reported case of pressure wire-guided EVT of CVSS. EVT appears to be a new option for CVSS, especially for patients with idiopathic intracranial hypertension, that can more smoothly alleviate the headache symptom and intravenous pressure gradients in these patients.5,6 Despite rapid developments in noninvasive imaging,

References (11)

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Cited by (6)

  • Dural venous sinus stenting in the treatment of idiopathic intracranial hypertension: A systematic review and critique of literature

    2022, Survey of Ophthalmology
    Citation Excerpt :

    This technique, named “Cobra”, was used in 30 cases where there was initial difficulty in advancing the stenosis, and was successful in all cases with no complications. Other modifications include the use of a pressure wire for hemodynamic assessment in lieu of traditional manometry to provide more accurate measurements and improve success rates, which was successfully performed in one case.57 One group used intravascular ultrasound as a clinical adjunct to allow for assessment of degree and type of stenosis and guidance of the stent in 12 patients without complications.103

  • Skull Base Neurointerventional Techniques

    2021, Neuroimaging Clinics of North America
    Citation Excerpt :

    MRV and CTV show anatomic stenosis in up to 93% of patients with IIH.22 Dural venous sinus stenosis can also be measured endovascularly, using intravascular ultrasonography or by measuring pressure gradients across the stenosis.23 For many operators, the indications for endovascular treatment include symptomatic IIH unresponsive to conservative treatment with evidence of transverse sinus stenosis and a pressure gradient greater than 8 mm Hg documented on a catheter venogram (Fig. 9A–C).22,24,25

  • Chinese expert consensus on the interventional management of venous sinus stenosis

    2021, Chinese Journal of Internal Medicine/Zhonghua Neike Zazhi

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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