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Kini A, Pahwa S, Sudhakar P. Double-Hit Mimics of Idiopathic Intracranial Hypertension. J Neuroophthalmol 2024; 44:e241-e243. [PMID: 37075284 DOI: 10.1097/wno.0000000000001831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Ashwini Kini
- Departments of Neurology (AK, PS), Ophthalmology (PS), and Neuro-radiology (SP), University of Kentucky, Lexington, Kentucky
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Buell TJ, Raper DMS, Ding D, Chen CJ, Wang TR, Taylor DG, Ilyas A, Kalani MYS, Park MS, Mahaney KB, Liu KC. Concurrent Venous Stenting of the Transverse and Occipito-Marginal Sinuses: An Analogy with Parallel Hemodynamic Circuits. J Neurosci Rural Pract 2019; 10:334-338. [PMID: 31001030 PMCID: PMC6454934 DOI: 10.4103/jnrp.jnrp_259_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Nonthrombotic intracranial venous occlusive disease (NIVOD) has been implicated in the pathophysiology of idiopathic intracranial hypertension (IIH) and various non-IIH headache syndromes. Endovascular stenting of stenotic, dominant transverse sinuses (TSs) may reduce trans-stenosis pressure gradients, decrease intracranial pressure, and alleviate symptoms in a subset of NIVOD patients. We present a case in which concurrent stenting of the occipito-marginal sinus obliterated the residual trans-stenosis pressure gradient across an initially stented dominant TS. We hypothesize that this observation may be explained using an electric-hydraulic analogy, and that this patient's dominant TS and occipito-marginal sinus may be modeled as a parallel hemodynamic circuit. Neurointerventionalists should be aware of parallel hemodynamic drainage patterns and consider manometry and possibly additional stenting of stenotic, parallel venous outflow pathways if TS stenting alone fails to obliterate the trans-stenosis pressure gradient.
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Affiliation(s)
- Thomas J Buell
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Daniel M S Raper
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dale Ding
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Tony R Wang
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Davis G Taylor
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mohammad Y S Kalani
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Min S Park
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Kelly B Mahaney
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kenneth C Liu
- Department of Neurosurgery, Pennsylvania State University, Hershey, Pennsylvania, USA
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Daggubati LC, Liu KC. Intracranial Venous Sinus Stenting: A Review of Idiopathic Intracranial Hypertension and Expanding Indications. Cureus 2019; 11:e4008. [PMID: 31001462 PMCID: PMC6450594 DOI: 10.7759/cureus.4008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 02/04/2019] [Indexed: 02/04/2023] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a functionally limiting disorder secondary to increased intracranial pressures (ICPs) with a prevalence of one per 100,000 persons. It is estimated to cost >$400 million per year in productively. Symptoms classically consist of chronic headaches, papilledema, and visual loss. The pathophysiology is unknown but postulated to involve increased resistance to cerebrospinal fluid (CSF) absorption. Traditional treatments involve weight loss, acetazolamide, CSF diversion, or optic nerve fenestration. More recent technology has allowed exploration of venous sinus stenosis. Through venous sinus stenting (VSS), the ICPs and venous sinus pressures decrease. After treatment, >75% exhibit an improvement in headaches, ~50% improvement in tinnitus, and ~50 % improvement in ophthalmologic testing. Complications are rare but involve stent stenosis, femoral pseudoaneurysm, and hemorrhages. Future studies will look into controlled studies for VSS as well as expansion to other venous structures of the intracranial circulation.
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Affiliation(s)
- Lekhaj C Daggubati
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Kenneth C Liu
- Neurosurgery, Penn State Milton Health S. Hershey Medical Center, Hershey, USA
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