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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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Miyoshi M, Tabuchi A, Mimura O, Nagahama A, Tabuchi H. A Case of Bilateral Papilledema With Improved Clinical Symptoms by Venous Stenting for Superior Sagittal Sinus Stenosis. Cureus 2023; 15:e43828. [PMID: 37736463 PMCID: PMC10509490 DOI: 10.7759/cureus.43828] [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] [Accepted: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
Superior sagittal sinus (SSS) obstruction causes intracranial hypertension, often requiring surgical stenting. Consensus on treating brain venous sinus stenosis, another cause, is lacking. This study reports a case of SSS stenosis and intracranial hypertension treated with venous stenting, improving bilateral papilledema. A 51-year-old with a headache and visual disturbance had papilledema and visual field loss. MR venography showed SSS stenosis, leading to a neurosurgery referral. Lumbar puncture confirmed intracranial hypertension (>35 cmH2O), prompting venous stenting. Post-procedure, papilledema, headache, and visual field loss improved. Venous stenting could be effective for SSS stenosis with clinically proven or recurrent pressure differences. Further cases are needed for standardization.
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Affiliation(s)
| | - Akio Tabuchi
- Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, JPN
| | - Osamu Mimura
- Ophthalmology, Hyogo College of Medicine, Nishinomiya, JPN
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Robert Bateman A, Alexander Bateman G, Barber T. Investigating the hemodynamic implications of triangular cross-sectioned superior sagittal sinus vessels and the errors associated with idealised modelling. J Biomech 2023; 149:111507. [PMID: 36868042 DOI: 10.1016/j.jbiomech.2023.111507] [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: 09/22/2022] [Revised: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
The superior sagittal sinus (SSS) is a blood vessel that is often observed to be approximately triangular in cross-section, due to how the venous wall attaches to the surrounding tissue. Despite this, the vessel has been assumed to be circular, when models are generated without patient-specific data. In this study, the differences between the cerebral hemodynamics of one circular, three triangular and five patient-specific cross-sectional models of a SSS were conducted. The errors associated with using circular cross-sectioned flow extensions were also determined. Computational fluid dynamics (CFD) models were generated from these geometries, with a population mean transient blood flow profile incorporated. The maximal helicity of the fluid flow was found to be elevated in the triangular cross-section, compared to the circular, with a higher wall shear stress (WSS) observed over a smaller, more concentrated region on the posterior sinus wall. The errors associated with using a circular cross-section were detailed, with the cross-sectional area appearing to have a greater influence on the hemodynamic parameters than the triangularity or circularity of the cross-section. This highlighted the importance of exhibiting caution when incorporating idealised modelling, especially when commenting on the true hemodynamics of these models. Errors were also found to be induced when using a circular cross-sectioned flow extension, for a geometry which was non-circular. This study highlights the importance of understanding the human anatomy when modelling blood vessels.
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Affiliation(s)
| | - Grant Alexander Bateman
- Department of Medical Imaging, John Hunter Hospital, Newcastle, NSW, Australia; Newcastle University Faculty of Health, Callaghan Campus, Newcastle, NSW, Australia
| | - Tracie Barber
- School of Mechanical Engineering, University of New South Wales, Sydney, NSW, Australia
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Korkmazer B, Karaman AK, Kızılkılıç EK, Unkun R, Arslan S, Uygunoğlu U, Kızılkılıç O, Koçer N, Islak C. Efficacy of Dural Sinus Quantitative Measurements in Idiopathic Intracranial Hypertension : A Practical Diagnostic Feature. Clin Neuroradiol 2022; 33:545-554. [PMID: 36577853 DOI: 10.1007/s00062-022-01244-0] [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: 08/17/2022] [Accepted: 11/17/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to investigate the potential contribution of quantitative measurements of dural venous sinuses to the diagnosis of idiopathic intracranial hypertension (IIH) and the relationship between IIH and dural venous sinus dimensions on 3D post-gadolinium T1-weighted magnetic resonance (MR) images. MATERIAL AND METHODS A total of 129 individuals (57 IIH patients and 72 controls) who complained of headache and underwent both magnetic resonance venography (MRV) and precontrast/postcontrast 3D T1-weighted MR imaging between 2018 and 2021 were included in this retrospective study. Dural venous sinus and jugular vein diameters were measured in all cases using post-gadolinium 3D T1 TFE images. The presence of transverse sinus (TS) hypoplasia and occipital sinus variation, the number and size of arachnoid granulations in the TS, and the presence of brain parenchymal herniation were also evaluated. Cut-off values that maximized accurate diagnosis of IIH were established on the receiver operating characteristic curve. The sensitivity and specificity of the diagnosis of IIH based on quantitative measurements of the dural sinus were calculated. RESULTS The ratios of the maximum to minimum TS diameters and the minimum TS diameters to minimum sigmoid sinus (SS) diameters were significantly higher in IIH patients than in the control group (p < 0.001). The diagnostic sensitivity and specificity values of TSmax/TSmin and TSmin sum/SSmin sum parameters for the detection of IIH were 84.2%, 84.7% and 83.3%, 84.2%, respectively. CONCLUSION Practical measurements from multiplanar T1 sequences can be useful for both quantitative assessment and overcoming misinterpretation due to anatomical variation.
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Affiliation(s)
- Bora Korkmazer
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
- , Cerrahpasa Tıp Fakültesi Yerleşkesi Kocamustafapasa Cd. No: 53 Cerrahpaşa, 34098, Fatih/Istanbul, Turkey.
| | - Ahmet Kursat Karaman
- Department of Radiology, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Esra Kochan Kızılkılıç
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rümeysa Unkun
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Arslan
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Uğur Uygunoğlu
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Osman Kızılkılıç
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Naci Koçer
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Civan Islak
- Division of Neuroradiology, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Sarrami AH, Bass DI, Rutman AM, Alexander MD, Aksakal M, Zhu C, Levitt MR, Mossa-Basha M. Idiopathic intracranial hypertension imaging approaches and the implications in patient management. Br J Radiol 2022; 95:20220136. [PMID: 35522777 PMCID: PMC10162046 DOI: 10.1259/bjr.20220136] [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: 01/27/2022] [Revised: 04/05/2022] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) represents a clinical disease entity without a clear etiology, that if left untreated, can result in severe outcomes, including permanent vision loss. For this reason, early diagnosis and treatment is necessary. Historically, the role of cross-sectional imaging has been to rule out secondary or emergent causes of increased intracranial pressure, including tumor, infection, hydrocephalus, or venous thrombosis. MRI and MRV, however, can serve as valuable imaging tools to not only rule out causes for secondary intracranial hypertension but can also detect indirect signs of IIH resultant from increased intracranial pressure, and demonstrate potentially treatable sinus venous stenosis. Digital subtraction venographic imaging also plays a central role in both diagnosis and treatment, providing enhanced anatomic delineation and temporal flow evaluation, quantitative assessment of the pressure gradient across a venous stenosis, treatment guidance, and immediate opportunity for endovascular therapy. In this review, we discuss the multiple modalities for imaging IIH, their limitations, and their contributions to the management of IIH.
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Affiliation(s)
- Amir Hossein Sarrami
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - David I. Bass
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Matthew D Alexander
- Department of Radiology, University of Utah, Salt Lake City, Utah, United States
| | - Mehmet Aksakal
- Department of Radiology, University of Washington, Seattle, United States
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, United States
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Johnson J, Anand A, Crowley S, Srivatsan A, Srinivasan V, Chintalapani G, Kan P. A retrospective anatomical study of the cerebral dural venous sinus outflow pathways utilizing three-dimensional rotational venography. Brain Circ 2022; 8:38-44. [PMID: 35372723 PMCID: PMC8973444 DOI: 10.4103/bc.bc_76_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE: Proper blood flow is essential for the maintenance of homeostasis for the human cerebrum. The dural venous sinuses comprise the dominant cerebral venous outflow path. Understanding the spatial configuration of the dural venous sinuses can provide valuable insight into several pathological conditions. Previously, only two-dimensional or cadaveric data have been used to understand cerebral outflow. For the first time, we applied three-dimensional rotational venography (3D-RV) to study and provide detailed quantitative morphological measurements of the terminal cerebral venous sinus system in several pathological states. SUBJECTS AND METHODS: Patients who underwent a 3D-RV procedure were identified by reviewing our local institution's endovascular database. Patients with high-quality angiographic images were selected. Eighteen patients were included (37.1 ± 3.8 years). Sinuses were divided into four segments, starting at the torcula and ending at the internal jugular vein. Segment length, 3D displacement, and cross-sectional area were measured. RESULTS: The transverse sinus (60.2 mm) was the longest segment, followed by the sigmoid sinus (55.1 mm). Cross-sectional areas were smallest at the middle of the transverse sinus (21.3 mm2) but increased at the sigmoid sinus (33.5 mm2) and at the jugular bulb (49.7 mm2). The only variation in displacements of venous flow was at the sigmoid-jugular junction, where 55% of cases had lateral displacements versus 45% medial, and 78% superior versus 22% inferior. CONCLUSIONS: We describe the terminal venous sinus system of patients with a variety of diagnoses, detailing segment length, cross-sectional area, and 3D path.
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Marshall-Goebel K, Kramer LA, Macias BR. The Importance of the Intracranial Compartment in the Development of Spaceflight-Associated Neuro-ocular Syndrome-Reply. JAMA Ophthalmol 2021; 140:99-100. [PMID: 34817558 DOI: 10.1001/jamaophthalmol.2021.4863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Larry A Kramer
- McGovern Medical School, University of Texas Health Science Center at Houston
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Serlin Y, Ben-Arie G, Lublinsky S, Flusser H, Friedman A, Shelef I. Distorted Optic Nerve Portends Neurological Complications in Infants With External Hydrocephalus. Front Neurol 2021; 12:596294. [PMID: 33597915 PMCID: PMC7882497 DOI: 10.3389/fneur.2021.596294] [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: 08/19/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Benign external hydrocephalus (BEH) is defined by rapid increase in head circumference in infancy, with neuroimaging evidence of enlarged cerebrospinal fluid (CSF) spaces. BEH was postulated to predispose to subdural hematoma, neurocognitive impairments, and autism. There is currently no consensus on BEH diagnostic criteria and no biomarkers to predict neurological sequalae. Methods: MRI-based quantitative approach was used for measurement of potential imaging markers related to external hydrocephalus and their association with neurological outcomes. We scanned 23 infants diagnosed with BEH and 11 age-similar controls. Using anatomical measurements from a large sample of healthy infants (n = 150), Z-scores were calculated to classify subject's CSF spaces as enlarged (≥1.96SD of mean values) or normal. Results: Subjects with abnormally enlarged CSF spaces had a significantly wider and longer ON (p = 0.017 and p = 0.020, respectively), and a significantly less tortuous ON (p = 0.006). ON deformity demonstrated a high diagnostic accuracy for abnormally enlarged frontal subarachnoid space (AUC = 0.826) and interhemispheric fissure (AUC = 0.833). No significant association found between enlarged CSF spaces and neurological complications (OR = 0.330, 95%CI 0.070-1.553, p = 0.161). However, cluster analysis identified a distinct subgroup of children (23/34, 67.6%) with enlarged CSF spaces and a wider, longer and less tortuous ON, to have an increased risk for neurological complications (RR = 7.28, 95%CI 1.07-49.40). Discussion: This is the first report on the association between external hydrocephalus, ON deformity and neurological complications. Our findings challenge the current view of external hydrocephalus as a benign condition. ON deformity is a potential auxiliary marker for risk stratification in patients with enlarged CSF spaces.
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Affiliation(s)
- Yonatan Serlin
- Neurology Residency Training Program, McGill University, Montreal, QC, Canada
| | - Gal Ben-Arie
- Department of Medical Imaging, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Svetlana Lublinsky
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Hagit Flusser
- Zussman Child Development Center, Division of Pediatrics, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Alon Friedman
- Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Department of Medical Neuroscience, Brain Repair Center, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ilan Shelef
- Department of Medical Imaging, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Hsieh YL, Xu X, Hsieh YD, Hsieh YC, Wang D, Guo P, Wang W. Hydroacoustic analysis and extraluminal compression surgical insights of venous pulsatile tinnitus. Auris Nasus Larynx 2021; 48:852-863. [PMID: 33468352 DOI: 10.1016/j.anl.2021.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to quantitatively and qualitatively evaluate the hydroacoustic changes from "presence" to "disappearance" of pulsatile tinnitus (PT) with the extraluminal compression surgical technique. The recent issues of concern pertaining to the hydroacoustic characteristics of sigmoid sinus wall anomalies and distal transverse sinus stenosis (dTSS) were discussed. METHODS This study was based on a retrospective case series. Seventy-seven patients with PT and transverse-sigmoid sinus enlargement with or without transverse-sigmoid sinus junction anomalies and transverse sinus stenosis (TSS) who had undergone extraluminal compression surgery under local anesthesia were included. Management of intractable intraoperative challenges and techniques for reversal extraluminal compression were introduced. Anatomical measurements, intraoperative color-coded Doppler ultrasonography, spectro-temporal analysis, and computational fluid dynamics were employed to analyze the hydroacoustic characteristics of PT. RESULTS The efficacy of the extraluminal compression technique was evident with the significant reduction in peak turbulent kinetic energy, vorticity, and mean pressure gradient at the transverse-sigmoid junction, resulting in over 20% reduction in PT amplitude. dTSS is a common finding in patients with PT exhibiting transverse-sigmoid sinus enlargement. Patients with dTSS presented with significant differences in hemodynamic characteristics as compared to those without. Linear regression analysis showed that the flow disturbance (turbulent kinetic energy and vorticity) was closely associated with the degree of dTSS, whereas the flow amplitude was not related to the degree or location of TSS. Low-pulsatory vortex flow at the transverse-sigmoid junction was visualized during an intraoperative color-coded Doppler examination, and the displayed low-frequency PT sound corresponded to the patients' subjective perception of PT. CONCLUSION (1) A reduction of over 20% of the flow-induced noise is the therapeutic goal of extraluminal compression technique. Since reductions in the magnitude of hemodynamic parameters, including turbulent kinetic energy, vorticity, and mean pressure gradient, render the flow-induced noise inaudible, besides sigmoid sinus wall anomalies, it is likely that PT develops from the aggregation of flow-based pathologies. (2) Although dTSS and diverticulum may greatly affect the hemodynamics at the transverse-sigmoid junction, in contrast to dehiscence, dTSS and diverticulum may not be the limiting factors for PT development.
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Affiliation(s)
- Yue-Lin Hsieh
- Fudan University, Shanghai, China; Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key laboratory of Hearing Science, Ministry of Health, Shanghai, China; Numerical and Scientific Computing Laboratory, National Formosa University, Yunlin, Taiwan
| | - Xiaobing Xu
- Fudan University, Shanghai, China; Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Yue-Da Hsieh
- Department of Economics, London School of Economics and Political Science, London, United Kingdom
| | - Yi-Chern Hsieh
- Department of Power Mechanical Engineering, National Formosa University, Yunlin, Taiwan; Numerical and Scientific Computing Laboratory, National Formosa University, Yunlin, Taiwan
| | - Dan Wang
- Fudan University, Shanghai, China; Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Ping Guo
- Fudan University, Shanghai, China; Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key laboratory of Hearing Science, Ministry of Health, Shanghai, China
| | - Wuqing Wang
- Fudan University, Shanghai, China; Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai 200031, China; Shanghai Auditory Medical Center, Shanghai, China; Key laboratory of Hearing Science, Ministry of Health, Shanghai, China.
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10
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Peterson KA, Kittel C, Lee KE, Garner R, Nechtman CM, Brown P, Wolfe SQ, Fargen KM. Angiographic cerebral venous sinus calibers and drainage patterns in patients with normal intracranial pressure and idiopathic intracranial hypertension. J Neurointerv Surg 2020; 13:958-963. [PMID: 33323500 DOI: 10.1136/neurintsurg-2020-016976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Normative venous sinus diameters are not well established. This study seeks to compare two-dimensional digital subtraction cerebral angiographic (DSA) venous sinus calibers for patients with normal intracranial pressure (ICP) and with idiopathic intracranial hypertension (IIH). METHODS Patients who underwent diagnostic cerebral angiography from 2016 to 2020 were retrospectively identified. Two independent reviewers measured venous sinus calibers from anteroposterior (AP) and lateral carotid injection delayed venous phase in patients from two groups (group 1: patients with normal ICP; group 2: patients with IIH) after receiving training in a standardized measurement protocol, with measurements obtained from the superior sagittal sinus (SSS) through the sigmoid sinuses (SS). RESULTS 97 patients from group 1 and 30 patients from group 2 were included. Interrater reliability was greater than 0.75 for all measured sites. Both groups had similar anatomical subtypes with most being right transverse sinus (TS) dominant or codominant. In group 1, men had significantly larger SSS on lateral view (p<0.001) and dominant TS calibers on AP view (p=0.02) compared with women. Both dominant TS measurements and SSS measurements (lateral plane) were significantly smaller among group 2 compared with group 1 (p<0.001 and 0.02, respectively). Patients with IIH had significantly larger dominant SS measurements (p=0.01). Bifid SSS anatomy was present in 9% of patients with mean caudal width 31 mm (range 19-49 mm). CONCLUSIONS This study is the first to provide two-dimensional DSA dural venous sinus calibers in patients with and without IIH and to compare anatomical drainage types and calibers among groups.
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Affiliation(s)
- Keyan A Peterson
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carol Kittel
- Division of Public Health Sciences, Department of Biostatistics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Katriel E Lee
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca Garner
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carl Mandel Nechtman
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Patrick Brown
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stacey Q Wolfe
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kyle M Fargen
- Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Dinkin M, Kesler A. Venous Stenting for Idiopathic Intracranial Hypertension. Neuroophthalmology 2019. [DOI: 10.1007/978-3-319-98455-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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12
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Pellerin A, Aguilar Garcia J, David A, Meyer J, Guyomarch Delasalle B, De Gaalon S, Auffray Calvier E, Desal H, Bourcier R. A quantitative and semi-automatic measurement of transverse sinus stenosis improves idiopathic intracranial hypertension diagnostic accuracy. J Neuroradiol 2018; 45:329-332. [DOI: 10.1016/j.neurad.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 02/03/2018] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
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13
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Boddu SR, Gobin P, Oliveira C, Dinkin M, Patsalides A. Anatomic measurements of cerebral venous sinuses in idiopathic intracranial hypertension patients. PLoS One 2018; 13:e0196275. [PMID: 29856739 PMCID: PMC5983447 DOI: 10.1371/journal.pone.0196275] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 04/07/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose Magnetic resonance venography (MRV) has not been validated in pre-operative planning of the dural venous sinus stenting (VSS) among idiopathic intracranial hypertension (IIH) patients. We aim to prospectively evaluate dural venous sinus measurement in IIH patient population on two-dimensional time-of-flight (2D-TOF) MRV and Three-dimensional contrast-enhanced (3D-CE) MRV acquisitions and compare them against real-time endoluminal measurements with intravascular ultrasound (IVUS), served as the reference. Materials and methods The study has been approved by the Weill Cornell Medicine institutional review board. All patients signed written informed consent approved by IRB. Prospective evaluation of forty-five consecutive IIH patients treated with VSS at our institution were evaluated. Patients with pre-stent magnetic resonance venography (MRV) ≤ 6-months of VSS and intravascular ultrasound (IVUS) during VSS constituted the study population. Maximum diameter (in mm), Area (in cm2) and Perimeter (in cm) were measured at posterior 1/3rd of superior sagittal sinus (SSS), proximal transverse sinus (PTS), proximal sigmoid sinus (PSS) and mid sigmoid sinus (MSS) on 2D-TOF-MRV, 3D-CE-MRV and IVUS. Statistical analysis performed using box and whisker plots, Bland-Altman analysis and paired sample t-test. Results Twenty (n = 20) patients constituted our study population. The mean age was 30±11 years (7–59 years) and 18 out of 20 were female patients. Mean weight and BMI (range) were 86.3±18.3 kilograms (30.8–107.5 kgs) and 32.9±6.8 kg/M2 (16.4–48.3kg/M2) respectively. The CE-MRV significantly oversized the cerebral venous sinuses compared to TOF-MRV (Dmax: +2.0±1.35 mm, p<0.001; Area: +13.31±10.92 mm2, p<0.001 and Perimeter: +4.79±3.4 mm, p<0.001) and IVUS (Dmax: +1.52±2.16 mm, p<0.001; Area: +10.03±21.5 mm2, p<0.001 and Perimeter: +4.15±3.27 mm, p<0.001). The TOF-MRV sinus measurements were in good agreement with the IVUS measurements with no significant variation (Dmax: +.21±2.23 mm, p = 0.49; Area: +2.51±20.41mm2, p = 0.347 and Perimeter: +.001±1.11 mm, p = 0.991). Conclusion We report baseline cerebral venous sinus measurements (maximum diameter, area and perimeter) in patients with idiopathic intracranial hypertension. In our experience, TOF-MRV is a reliable representation of endoluminal cerebral venous sinus dimensions, and CE-MRV measurements reflected an overestimation of the endoluminal sinus dimensions when compared against the real time IVUS measurements.
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Affiliation(s)
- Srikanth R Boddu
- Division of Interventional Neuroradiology, Department of Neurological surgery, New York Presbyterian Hospital / Weill Cornell Medical Center, New York, NY, United States of America.,Interventional Neuroradiology, New York Presbyterian Queens Hospital, Flushing, NY, United States of America
| | - Pierre Gobin
- Division of Interventional Neuroradiology, Department of Neurological surgery, New York Presbyterian Hospital / Weill Cornell Medical Center, New York, NY, United States of America
| | - Cristiano Oliveira
- Department of Ophthalmology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, United States of America
| | - Marc Dinkin
- Department of Ophthalmology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, United States of America
| | - Athos Patsalides
- Division of Interventional Neuroradiology, Department of Neurological surgery, New York Presbyterian Hospital / Weill Cornell Medical Center, New York, NY, United States of America
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14
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Lublinsky S, Kesler A, Friedman A, Horev A, Shelef I. Quantifying response to intracranial pressure normalization in idiopathic intracranial hypertension via dynamic neuroimaging. J Magn Reson Imaging 2017; 47:913-927. [PMID: 28960686 DOI: 10.1002/jmri.25857] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure without a clear cause. PURPOSE To investigate dynamic imaging findings in IIH and their relation to mechanisms underlying intracranial pressure normalization. STUDY TYPE Prospective. POPULATION Eighteen IIH patients and 30 healthy controls. FIELD STRENGTH/SEQUENCE T1 -weighted, venography, fluid attenuation inversion recovery, and apparent diffusion coefficients were acquired on 1.5T scanner. ASSESSMENT The dural sinus was measured before and after lumbar puncture (LP). The degree of sinus occlusion was evaluated, based on 95% confidence intervals of controls. We studied a number of neuroimaging biomarkers associated with IIH (sinus occlusion; optic nerve; distribution of cerebrospinal fluid into the subarachnoid space, sulci and lateral ventricles (LVs); Meckel's caves; arachnoid granulation; pituitary and choroid plexus), before and after LP, using a set of specially developed quantification techniques. STATISTICAL TESTS Relationships among various biomarkers were investigated (Pearson correlation coefficient) and linked to long-term disease outcomes (logistic regression). The t-test and the Wilcoxon rank test were used to compare between controls and before and after LP data. RESULTS As a result of LP, the following were found to be in good accordance with the opening pressure: relative compression of cerebrospinal fluid (R = -0.857, P < 0.001) and brain volumes (R = -0.576, P = 0.012), LV expansion (R = 0.772, P < 0.001) and venous volume (R = 0.696, P = 0.001), enlargement of the pituitary (R = 0.640, P = 0.023), and shrinkage of subarachnoid space (R = -0.887, P < 0.001). The only parameter that had an impact on long-term prognosis was cross-sectional size of supplemental drainage veins after LP (sensitivity of 92%, specificity of 20%, and area under the curve of 0.845, P < 0.001). DATA CONCLUSION We present an approach for quantitative characterization of the intracranial venous system and its implementation as a diagnostic assistance tool. We conclude that formation of supplementary drainage veins might serve as a long-lasting compensatory mechanism. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:913-927.
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Affiliation(s)
- Svetlana Lublinsky
- Departments of Brain & Cognitive Sciences, Physiology & Cell Biology, Faculty of Health Science, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anat Kesler
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Friedman
- Departments of Brain & Cognitive Sciences, Physiology & Cell Biology, Faculty of Health Science, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anat Horev
- Soroka University Medical Center, Diagnostic Imaging Department, Beer-Sheva, Israel
| | - Ilan Shelef
- Soroka University Medical Center, Diagnostic Imaging Department, Beer-Sheva, Israel
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15
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Bateman GA, Lechner-Scott J, Copping R, Moeskops C, Yap SL. Comparison of the sagittal sinus cross-sectional area between patients with multiple sclerosis, hydrocephalus, intracranial hypertension and spontaneous intracranial hypotension: a surrogate marker of venous transmural pressure? Fluids Barriers CNS 2017; 14:18. [PMID: 28679427 PMCID: PMC5499004 DOI: 10.1186/s12987-017-0066-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022] Open
Abstract
There is evidence that patients with multiple sclerosis (MS) and hydrocephalus share some common pathophysiological mechanisms. Alterations in CSF pressure are known to affect cerebral venous sinus geometry. To further explore these mechanisms, we measured the superior sagittal sinus (SSS) cross-sectional area 3 cm above the torcular using T2 images in 20 MS, 10 spontaneous intracranial hypotension (SIH), 21 hydrocephalus and 20 idiopathic intracranial hypertension (IIH) patients and compared with 20 matched controls. The SSS area was reduced by 25% in hydrocephalus (p = 0.0008), increased by 22% (p = 0.037) in SIH and unchanged in IIH compared to matched controls. In MS there was a 16% increase in SSS area (p = 0.01).The findings suggest that changes in SSS cross-sectional are common between MS and SIH patients, while in hydrocephalus and IIH these are different.
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Affiliation(s)
- Grant A Bateman
- Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Center, Newcastle, 2310, Australia. .,Newcastle University Faculty of Health, Callaghan Campus Newcastle, Newcastle, Australia.
| | - Jeannette Lechner-Scott
- Newcastle University Faculty of Health, Callaghan Campus Newcastle, Newcastle, Australia.,Department of Neurology, John Hunter Hospital, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Ross Copping
- Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Center, Newcastle, 2310, Australia
| | - Christopher Moeskops
- Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Center, Newcastle, 2310, Australia
| | - Swee Leong Yap
- Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Center, Newcastle, 2310, Australia
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16
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Anconina R, Zur D, Kesler A, Lublinsky S, Toledano R, Novack V, Benkobich E, Novoa R, Novic EF, Shelef I. Creating normograms of dural sinuses in healthy persons using computer-assisted detection for analysis and comparison of cross-section dural sinuses in the brain. J Clin Neurosci 2017; 40:190-194. [PMID: 28286027 DOI: 10.1016/j.jocn.2017.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 11/14/2016] [Accepted: 02/07/2017] [Indexed: 11/18/2022]
Abstract
Dural sinuses vary in size and shape in many pathological conditions with abnormal intracranial pressure. Size and shape normograms of dural brain sinuses are not available. The creation of such normograms may enable computer-assisted comparison to pathologic exams and facilitate diagnoses. The purpose of this study was to quantitatively evaluate normal magnetic resonance venography (MRV) studies in order to create normograms of dural sinuses using a computerized algorithm for vessel cross-sectional analysis. This was a retrospective analysis of MRV studies of 30 healthy persons. Data were analyzed using a specially developed Matlab algorithm for vessel cross-sectional analysis. The cross-sectional area and shape measurements were evaluated to create normograms. Mean cross-sectional size was 53.27±13.31 for the right transverse sinus (TS), 46.87+12.57 for the left TS (p=0.089) and 36.65+12.38 for the superior sagittal sinus. Normograms were created. The distribution of cross-sectional areas along the vessels showed distinct patterns and a parallel course for the median, 25th, 50th and 75th percentiles. In conclusion, using a novel computerized method for vessel cross-sectional analysis we were able to quantitatively characterize dural sinuses of healthy persons and create normograms.
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Affiliation(s)
- Reut Anconina
- Radiology Institute, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Dinah Zur
- Ophthalmology Division, Sourasky Medical Center, Tel Aviv University, Tel-Aviv, Israel.
| | - Anat Kesler
- Ophthalmology Division, Sourasky Medical Center, Tel Aviv University, Tel-Aviv, Israel.
| | - Svetlana Lublinsky
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Ronen Toledano
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Elya Benkobich
- Radiology Institute, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Rosa Novoa
- Radiology Institute, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Evelyne Farkash Novic
- Radiology Institute, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Ilan Shelef
- Radiology Institute, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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17
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Zur D, Anconina R, Kesler A, Lublinsky S, Toledano R, Shelef I. Quantitative imaging biomarkers for dural sinus patterns in idiopathic intracranial hypertension. Brain Behav 2017; 7:e00613. [PMID: 28239523 PMCID: PMC5318366 DOI: 10.1002/brb3.613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/06/2016] [Accepted: 10/17/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To quantitatively characterize transverse dural sinuses (TS) on magnetic resonance venography (MRV) in patients with idiopathic intracranial hypertension (IIH), compared to healthy controls, using a computer assisted detection (CAD) method. MATERIALS AND METHODS We retrospectively analyzed MRV studies of 38 IIH patients and 30 controls, matched by age and gender. Data analysis was performed using a specially developed Matlab algorithm for vessel cross-sectional analysis. The cross-sectional area and shape measurements were evaluated in patients and controls. RESULTS Mean, minimal, and maximal cross-sectional areas as well as volumetric parameters of the right and left transverse sinuses were significantly smaller in IIH patients than in controls (p < .005 for all). Idiopathic intracranial hypertension patients showed a narrowed segment in both TS, clustering near the junction with the sigmoid sinus. In 36% (right TS) and 43% (left TS), the stenosis extended to >50% of the entire length of the TS, i.e. the TS was hypoplastic. Narrower vessels tended to have a more triangular shape than did wider vessels. CONCLUSION Using CAD we precisely quantified TS stenosis and its severity in IIH patients by cross-sectional and volumetric analysis. This method can be used as an exact tool for investigating mechanisms of IIH development and response to treatment.
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Affiliation(s)
- Dinah Zur
- Division of Ophthalmology Sackler Faculty of Medicine Tel Aviv Sourasky Medical Center Tel Aviv University Tel Aviv Israel
| | - Reut Anconina
- Diagnostic Imaging Department Soroka University Medical Center Ben-Gurion University of the Negev Beer-Sheva Israel
| | - Anat Kesler
- Division of Ophthalmology Sackler Faculty of Medicine Tel Aviv Sourasky Medical Center Tel Aviv University Tel Aviv Israel
| | - Svetlana Lublinsky
- Zolotowsky Neuroscience Center Ben-Gurion University of the Negev Beer-Sheva Israel
| | - Ronen Toledano
- Clinical Research Center Soroka University Medical Center Ben-Gurion University of the Negev Beer-Sheva Israel
| | - Ilan Shelef
- Diagnostic Imaging Department Soroka University Medical Center Ben-Gurion University of the Negev Beer-Sheva Israel
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