Dural Fistula Research Articles

What Should Otolaryngologists Know About Dural Venous Sinus Stenting?

Dural venous sinus stenting is an emerging and exciting area in otolaryngology in collaboration with neurosurgeons and neuroradiologists. The first cases were reported 20 years ago. It is now considered part of the routine treatment of increased intracranial pressure due to transverse sinus stenosis.

Tortuous occipital emissary vein combined with dural venous sinus stenosis in contrast-enhanced MRV for evaluation of idiopathic intracranial hypertension.

Venous outflow impediment is increasingly recognized in idiopathic intracranial hypertension (IIH). We aim to search for the value of tortuous occipital emissary vein (OEV) in IIH by integrating measurable transverse sinus (TS) stenosis in contrast-enhanced MR venography (CE-MRV). Twenty-one IIH patients were evaluated with CE-MRV. Each patient had high LP opening pressure (> 25cm.H2O), and presented papilledema. Age- and sex-matched 21 control subjects who underwent cranial CE-MRV were selected. The OEV and the following features: intraosseous diameter of more than 3mm, twisted course, and continuous with prominent sub-occipital extracranial veins were named tortuous OEV. TS stenosis was measured by utilizing the coronal T1-VIBE series to calculate quantitative metrics such as TS max./min.. The tortuous OEV and TS max./min. were registered to create a bivariate logistic regression model to assess the performance of tortuous OEV for IIH when accompanied by TS stenosis. Six (29%) tortuous OEVs were observed in the IIH group, while no tortuous OEV was identified in the control group (p = 0.021). The mean TSmax./min. was 2.48 ± 1.19 in patients with IIH and 1.23 ± 0.33 in the control group (p < 0.001). According to regression analysis, tortuous OEV is not predictive of IIH (p = 0.999), while the higher TSmax./min. (> 1.69) is predictive of IIH (p = 0.022, OR: 8.9; %95 CI; 1.4-59.0) when accompanied together. Tortuous occipital emissary vein is more frequently seen in patients with IIH. However, the tortuous appearance alone does not predict idiopathic intracranial hypertension unless associated with measurable transverse sinus narrowing in CE-MRV.

Enhancing thromboresistance of neurovascular nickel-titanium devices with responsive heparin hydrogel coatings

BackgroundNeurointerventional devices, particularly laser-cut thin-strut stents made of self-expanding nickel-titanium alloy, are increasingly utilized for endovascular applications in intracranial arteries and dural venous sinuses. Preventing thrombosis and stroke necessitates systemic...

Temporal bone marrow of the rat and its connections to the inner ear.

Calvarial bone marrow has been found to be central in the brain immune response, being connected to the dura through channels which allow leukocyte trafficking. Temporal bone marrow is thought to play important roles in relation to the inner ear, but is still largely uncharacterized, given this bone complex anatomy. We characterized the geometry and connectivity of rat temporal bone marrow using lightsheet imaging of cleared samples and microCT. Bone marrow was identified in cleared tissue by cellular content (and in particular by the presence of megakaryocytes); since air-filled cavities are absent in rodents, marrow clusters could be recognized in microCT scans by their geometry. In cleared petrosal bone, autofluorescence allowed delineation of the otic capsule layers. Within the endochondral layer, bone marrow was observed in association to the cochlear base and vestibule, and to the cochlear apex. Cochlear apex endochondral marrow (CAEM) was a separated cluster from the remaining endochondral marrow, which was therefore defined as "vestibular endochondral marrow" (VEM). A much larger marrow island (petrosal non-endochondral marrow, PNEM) extended outside the otic capsule surrounding semicircular canal arms. PNEM was mainly connected to the dura, through bone channels similar to those of calvarial bone, and only a few channels were directed toward the canal periosteum. On the contrary, endochondral bone marrow was well connected to the labyrinth through vascular loops (directed to the spiral ligament for CAEM and to the bony labyrinth periosteum for VEM), and to dural sinuses. In addition, CAEM was also connected to the tensor tympani fossa of the middle ear and VEM to the endolymphatic sac. Endochondral marrow was made up of small lobules connected to each other and to other structures by channels lined by elongated macrophages, whereas PNEM displayed larger lobules connected by channels with a sparse macrophage population. Our data suggest that the rat inner ear is surrounded by bone marrow at the junctions with middle ear and brain, most likely with "customs" role, restricting pathogen spread; a second marrow network with different structural features is found within the endochondral bone layer of the otic capsule and may play different functional roles.

Chordae Willisii of the dural sinuses: an anatomical study using magnetic resonance imaging.

The chordae Willisii (CWs), trabecular projections into the lumen of the dural sinuses, are not well understood. We aimed to explore them using magnetic resonance imaging (MRI). Eighty-five patients underwent volumetric contrast-enhanced MRI, while another 30 underwent a fluid-attenuated inversion recovery (FLAIR) sequence in the coronal section. The CWs were detected as linear filling defects lying in the dural sinuses, adjacent to the surrounding dura mater. They were found in the superior sagittal sinus (SSS) in 68.2% of the patients, most frequently in the middle third, with laminar appearance. In 27.1% of the patients, the CWs divided the SSS lumen into separate channels. The CWs were identified in the transverse sinus, transverse-sigmoid sinus junctional area and sigmoid sinus, and straight sinus in 54.1, 47.1, and 8.2%, respectively. On the FLAIR images, dural septi partially dividing the SSS lumen were identified in all patients. In addition, in 73.3% of the patients, fine linear structures were observed in the lumen with inconstant arrangements. The CWs may be constant structures distributed over the lumen of the intracranial dural sinuses. Contrast-enhanced MRI may be useful for detecting laminar CWs. The FLAIR sequence may be advantageous for delineating the dural septi projecting into the lumen of the dural sinuses.

Assessment of verbal (conventional) training versus models training for head frame fixation in neurosurgery

Cranial immobilization is an essential first step in cranial surgeries. Complications related to head fixation frames are under-reported and given less importance during training. Authors report their experience of using verbal (Conventional) training and training by models of “head fixation frame” and “wooden head” for head frame application for cranial surgeries. Models of the “Head Fixation Frame” (Mayfield clamp) and “wooden human head” were made using metal (iron) and wood, respectively. Major craniometric landmarks and dural venous sinuses were marked on the head model. A total of 15 trainee residents of &gt;18 months (Group A, n = 4), &lt; 18 months (Group B, n = 5), and without neurosurgical training (Group C, n = 6) were assessed for head frame application on human cadaver heads after verbal (conventional) training (n = 8) and training on models (n = 7). Various parameters, such as time taken for pin application, selection of pin site, and quadrants, were evaluated for adequacy of pin placements and position of head. Both methods were compared for assessment of better training method. Model training for head frame fixation was found better with regard to all aspects out of which time for positioning the head and for pin application, selection of quadrants of the head, site for pin insertions, and need of intervention by faculty were significant. Training on models of “head fixation frame” and “head” is better than conventional training. It is simple and safe and will prevent pin-related complications.

Occipital venous sinus stenting for idiopathic intracranial hypertension and pulsatile tinnitus: A case series.

Venous sinus stenting for dural venous sinus outflow obstruction due to an intrinsic filling obstruction or extrinsic stenosis is an increasingly popular treatment strategy for idiopathic intracranial hypertension (IIH) and isolated pulsatile tinnitus (PT). The most common site of stenosis is the lateral venous sinus at the transverse-sigmoid junction. Approximately 10% of the population has a persistent occipital venous sinus (OVS), a variant that may be the dominant venous drainage pathway in the setting of a hypoplastic or aplastic transverse sinus. OVS stenosis has been rarely associated with IIH and isolated PT with only a handful published cases. We herein report a retrospective series of OVS stenting in five patients, four of whom presented with non-IIH PT and one with IIH.

Sex-based difference in selected stroke etiologies: cerebral dural sinus venous thrombosis, reversible cerebral vasoconstriction syndrome, dissection, migraine, pregnancy/puerperium/OC use

Females are at higher risk than males for a multitude of cerebrovascular conditions, both common and rare; partially resulting from a complex interplay between differing process involving genetics, hormonal influences, common cerebrovascular risk factors among others. Specific topics including cervical artery dissection, cerebral dural sinus venous thrombosis, reversible cerebral vasoconstriction syndrome, migraine, along with these disorders in the setting of pregnancy, puerperium and oral contraceptive utilization. Epidemiology, pathophysiology, presentation, basics of management and outcomes are presented, with sex differences throughout.

Characteristics of Cerebral Venous Sinus Thrombosis Due to Autoimmune Diseases: A Single-Center Retrospective Observational Study.

Cerebral venous sinus thrombosis (CVST) is a cerebrovascular disease characterized by thrombosis of the cerebral venous or dural sinuses. Autoimmune diseases (AD) are important causes of CVST. This study aims to reveal the differences between CVST associated with autoimmune diseases compared with other causes (OCs) and Behcet's syndrome (BS) compared with other ADs. This is a single-center retrospective study in which the medical records of 187 patients we followed with a diagnosis of CVST between 2008 and 2023 were collected retrospectively. Four neurologists collected data on initial symptoms, neurological examinations, and laboratory findings. Findings on magnetic resonance imaging and magnetic resonance venography performed on all patients (thrombosis localizations, hemorrhagic or ischemic complications, and collateralization) were re-evaluated by 2 radiologists. The results were compared with AD, other ADs, and OCs groups. There were 28 cases of CVST associated with AD. Of these, 18 were BS, and 10 were other AD. Subacute-chronic onset, headache, and transverse sinus involvement were more common in AD-related patients than in OCs. However, collateralization, venous infarction, hemorrhagic transformation, and bleeding were less common. BS-related patients had earlier age, more frequent transverse sinus, less frequent cortical vein thrombosis, and better collateralization than other ADs. CVST is one of the rare complications in autoimmune diseases. It has a more subacute-chronic onset. Since headaches are more common, it is essential to make a differential diagnosis of CVST in autoimmune diseases with chronic headaches. Transverse sinus thrombosis is more common. Collateralization, venous infarction, and hemorrhagic transformation are less.

Basal Vein of Rosenthal, Vein of Galen, and Straight Sinus

The basal vein of Rosenthal, the vein of Galen, and the straight sinus are important venous communication routes connecting the deep, superficial, and dural sinuses. The basal vein is divided into three parts since it originates secondarily from three different areas and its venous areas are diverse. However, care should be taken because disconnection between these segments causes variations that change the venous flow path. Endovascular treatment warrants a proper understanding of this anatomical area and requires consideration of vascular occlusion and venous drainage changes.

Anatomy of the Cavernous Sinus

The cavernous sinus is the crossroad of veins from various embryological origins, including the brain, eye, pituitary gland, dura, and cranium. Embryologically, the cavernous sinus is mainly formed from the pro-otic sinus; secondary anastomosis between the cavernous sinus and primitive tentorial sinus results in various anatomical variations in the drainage patterns of the superficial middle cerebral vein. Moreover, connections between the cavernous sinus and basal vein via the uncal vein, bridging vein, and petrosal vein from the superior petrosal sinus may exist. Retrograde drainage from the cavernous sinus into the cerebral veins is often observed in arteriovenous shunts involving the cavernous sinus, such as dural and carotid-cavernous fistulas, which are primarily treated using transvenous embolization. Understanding the anatomy of the cavernous sinus and its associated veins is essential for safe and reliable endovascular treatment.

The role of surgical disconnection for posterior fossa pial arteriovenous fistulas and dural fistulas with pial supply: an illustrative case series.

Pial arteriovenous fistulas (pAVFs) are rare vascular malformations characterized by high-flow arteriovenous shunting involving a cortical arterial supply directly connecting to venous drainage without an intermediate nidus. Dural arteriovenous fistulas (dAVFs) can infrequently involve additional pial feeders which can introduce higher flow shunting and increase the associated treatment risk. In the posterior fossa, arteriovenous fistula (AVF) angioarchitecture tends to be particularly complex, involving either multiple arterial feeders-sometimes from both dural and pial origins-or small caliber vessels that are difficult to catheterize and tend to be intimately involved with functionally critical brainstem or upper cervical cord structures. Given their rarity, published experience on microsurgical or endovascular treatment strategies for posterior fossa pAVFs and dAVFs with pial supply remains limited. Retrospective chart review from 2019-2023 at a high-volume center identified six adult patients with posterior fossa pAVFs that were unable to be fully treated endovascularly and required microsurgical disconnection. These cases are individually presented with a technical emphasis andsupported by comprehensive angiographic and intraoperative images. One vermian (Case 1), three cerebellopontine angle (Cases 2-4) and two craniovertebral junction (Cases 5-6) posterior fossa pAVFs or dAVFs with pial supply are presented. Three cases involved mixed dural and pial arterial supply (Cases 1, 4, and 6), and one case involved a concomitant microAVM (Case 2). Endovascular embolization was attempted in four cases (Cases 1-4): The small caliber and tortuosity of the main arterial feeder prevented catheterization in two cases (Cases 1 and 3). Partial embolization was achieved in Cases 2 and 4. In Cases 5 and 6, involvement of the lateral spinal artery or anterior spinal artery created a prohibitive risk forendovascular embolization, and surgical clip ligation was pursued as primary management. In all cases, microsurgical disconnection resulted in complete fistula obliteration without evidence of recurrence on follow-up imaging (mean follow-up 27.1 months). Two patients experienced persistent post-treatment sensory deficits without significant functional limitation. This illustrative case series highlights thetechnical difficulties and anatomical limitations of endovascular management for posterior fossa pAVFs and dAVFs with pial supply and emphasizes the relative safety and utility of microsurgical disconnection in this context. A combined approach involving partial preoperative embolization-when the angioarchitecture is permissive-can potentially decrease surgical morbidity. Larger studies are warranted to better define the role for multimodal intervention and to assess associated long-term AVF obliteration rates in the setting of pial arterial involvement.

ACCURACY OF SUSCEPTIBILITY WEIGHTED IMAGING AND 3D-TOF MRA IN DETECTION AND PRE-TREATMENT EVALUATION OF INTRACRANIAL DURAL ARTERIOVENOUS FISTULAS

Background: Dural arteriovenous fistulas (DAVFs) are abnormal connections between meningeal arteries and dural venous sinuses or cortical veins. A cerebral angiogram is the gold standard for diagnosing and treating DAVFs. Still, non-invasive techniques such as three-dimensional time-offlight magnetic resonance angiography (3D-TOF MRA) and susceptibility-weighted imaging (SWI) are also helpful in evaluating the location and severity of the fistulas, including cortical venous reflux (CVR) and cortical venous ectasia (CVE). This study aimed to compare the efficacy in detecting and pretreating DAVFs evaluating SWI and 3D-TOF MRA with cerebral angiography. Methods: The retrospective study included 35 patients with 41 DAVFs who underwent pre-treatment MR imaging and cerebral angiogram. The fistulous point at convexity and cavernous locations, arterial feeders, venous drainers, CVR, and CVE were evaluated. Results: SWI and 3D-TOF MRA showed high sensitivity and excellent specificity in detecting DAVFs Cognard II-IV at convexity location and high sensitivity in evaluating CVR. For DAVFs at cavernous sinus locations, arterial feeders and venous drainers were significantly identified in 3D-TOF MRA (p &lt; 0.001). SWI exhibited superior sensitivity (87.5%) in detecting CVE at convexity locations (p &lt; 0.001). Slow flow or low-grade fistulas in cavernous sinus locations (n = 2, 4.8%, Cognard I) were not identified using MR imaging. Conclusion: SWI and 3D-TOF MRA are helpful tools for evaluating high-flow DAVFs (Cognard II-IV). SWI is superior in detecting CVE in convexity locations but is limited in assessing the fistulous point in cavernous sinus locations. Thus, combining findings from both SWI and 3D-TOF MRA exhibited high accuracy in detecting and pretreating high-flow DAVFs.

New recommendations on cerebral venous and dural sinus thrombosis from the German consensus-based (S2k) guideline

Over the last years, new evidence has accumulated on multiple aspects of diagnosis and management of cerebral venous and dural sinus thrombosis (CVT) including identification of new risk factors, studies on interventional treatment as well as treatment with direct oral anticoagulants. Based on the GRADE questions of the European Stroke Organization guideline on this topic, the new German guideline on CVT is a consensus between expert representatives of Austria, Germany and Switzerland. New recommendations include:• CVT occurring in the first weeks after SARS-CoV-2 vaccination with vector vaccines may be associated with severe thrombocytopenia, indicating the presence of a prothrombotic immunogenic cause (Vaccine-induced immune thrombotic thrombocytopenia; VITT).• D-dimer testing to rule out CVT cannot be recommended and should therefore not be routinely performed.• Thrombophilia screening is not generally recommended in patients with CVT. It should be considered in young patients, in spontaneous CVT, in recurrent thrombosis and/or in case of a positive family history of venous thromboembolism, and if a change in therapy results from a positive finding.• Patients with CVT should preferably be treated with low molecular weight heparine (LMWH) instead of unfractionated heparine in the acute phase.• On an individual basis, endovascular recanalization in a neurointerventional center may be considered for patients who deteriorate under adequate anticoagulation.• Despite the overall low level of evidence, surgical decompression should be performed in patients with CVT, parenchymal lesions (congestive edema and/or hemorrhage) and impending incarceration to prevent death.• Following the acute phase, oral anticoagulation with direct oral anticoagulants instead of vitamin K antagonists should be given for 3 to 12 months to enhance recanalization and prevent recurrent CVT as well as extracerebral venous thrombosis.• Women with previous CVT in connection with the use of combined hormonal contraceptives or pregnancy shall refrain from continuing or restarting contraception with oestrogen–progestagen combinations due to an increased risk of recurrence if anticoagulation is no longer used.• Women with previous CVT and without contraindications should receive LMWH prophylaxis during pregnancy and for at least 6 weeks post partum.Although the level of evidence supporting these recommendations is mostly low, evidence from deep venous thrombosis as well as current clinical experience can justify the new recommendations.This article is an abridged translation of the German guideline, which is available online.

Drying up the drip- A case report

Cerebral Venous sinus thrombosis is an uncommon entity, which is usually associated with thrombosis of the dural venous sinuses due to local and clotting mechanism abnormalities. CVT secondary to CSF rhinorrhea has been recorded in literature but the relationship is uncertain. Here we report a case of a 28yr old male with a past history of road traffic accident who presented with features suggestive of meningoencephalitis. He was diagnosed to have Cortical Venous Thrombosis, on further evaluation he was found to have CSF rhinorrhea.

Diagnostic Accuracy of Hounsfield Unit Value and Hounsfield Unit to Hematocrit Ratio in Predicting Cerebral Venous Sinus Thrombosis: A Retrospective Case-Control Study.

Non-contrast computed tomography (CT) of the brain is a primary neuroimagingmodalityin emergencypatients suspected of having cerebral venous sinus thrombosis (CVST). Theobjective of thestudy was to determine thediagnostic accuracy of Hounsfield unit (HU) values and the ratio of HU to hematocrit value (HU/Htc) inpredicting CVST in suspected patients. A retrospective, case-control study was done in a tertiary care institute which included 35 patients with CVST constituted as cases and 41 patients without CVST as controls on the basis of magnetic resonance venography (MRV). Non-contrast CT brain of all 76 subjects were assessed by two experienced radiologists independently. HU values of dural venous sinuses were calculated in both groups, and HU/Htc ratio was also determined.StatisticalPackage for Social Sciences (SPSS) version 25.0(SPSS© for Windows, IBM© Corp.) was used for statistical analysis. Independent samples t-test was applied to compare the means of continuous variables. The diagnostic values were computed using the Calculator 1 tool on clinical research calculators tab on vassarstats.net. The predictive values of HU and HU/Htc ratio were estimated by the receiver operating characteristic (ROC) curve analysis. In CVST group, the mean Hounsfield Unit (HU) value was "75.9±3.9 (mean±SD)", while in control group, it was57.78±4.65 (mean±SD), p < 0.001. The mean HU/Htc ratio was 1.98±0.42 (mean±SD) in the CVST group and 1.51±0.12 (mean±SD) in the control group (p < 0.001). Optimum cut-off HU value was calculated as 68, with 97% sensitivity and 100% specificity. For HU/Htc ratio, optimum cut-off was calculated as 1.69, yielding 71.4% sensitivity and 100% specificityon the basis of ROC curves. The difference was not statistically significant in hemoglobin and hematocrit (Htc) values between the cases and controls. Thequantitative measurementslike HU value and HU/Htc ratioprovidean easily obtainable metric inpatients with suspected CVST on non-contrast CT brain, thusenhancing the role ofnon-contrast CT brain in diagnosing CVST.

434 Concurrent Vascular and Traumatic Brain Injury: Effect on Patient Outcomes

INTRODUCTION: Dural venous sinus thrombosis (DVST) in select populations following traumatic brain injury (TBI), including those with blunt mechanism or depressed skull fractures, have been associated with an increased risk of mortality. METHODS: We performed a retrospective case-control study of data from our institutional trauma registry from 2004-2021. Patients were divided into three groups: those with imaging confirmed DVST, those with imaging confirmed DVST and blunt cerebrovascular injury (BCVI), and a control group of TBI patients with cerebrovascular imaging without DVST or BCVI. All age groups and injury mechanisms were included with a head abbreviated injury score (AIS) of = 3. Demographics, injury characteristics, and patient outcomes were collected. Between group differences were compared with non-parametric tests as appropriate. Multivariate logistic regression was carried out to identify predictors of inpatient mortality. RESULTS: We identified 9,875 patients over the time-period with TBIs, with a 1.64% incidence of DVST and 23.4% incidence of concurrent BCVI. Despite a more severe presenting injury profile in those with DVST, the presence of DVST itself was not significantly associated with inpatient mortality (OR 1.02; 0.26-3.69). On regression analysis an occlusive DVST (OR 1.34; 1.15-1.56) and not receiving treatment (OR 1.27; 1.01-1.60) were independently associated with inpatient mortality. Significantly worse functional outcomes were observed in those with DVST+BCVI at 6-months, though a high proportion of patients achieved a GOSE of 7 or 8. CONCLUSIONS: We observed an incidence of traumatic DVST of 1.64% in a mixed population of head injured patients, with 23.4% of patients having concurrent BCVI. The presence of DVST alone was not significantly associated with inpatient mortality.

Angulation of the dural venous sinuses of the posterior cranial fossa: Anatomical study with clinical and surgical applications.

Cerebral vein and dural venous sinus thromboses (CVST) account for 0.5%-1% of all strokes. Some structural factors associated with a potentially higher risk for developing CVST have been described. However, angulation of the dural venous sinuses (DVS) has yet to be studied as a structural factor. The current study was performed because this variable could be related to alterations in venous flow, thus predisposing to a greater risk of CVST development. Additionally, such information could help shed light on venous sinus stenosis (VSS) at or near the transverse-sigmoid junction. The angulations formed in the different segments of the grooves of the transverse (TS), sigmoid (SS), and superior sagittal sinuses (SSS) were measured in 52 skulls (104 sides). The overall angulation of the TS groove was measured using two reference points. Other variables were examined, such as the communication pattern at the sinuses' confluence and the sinus grooves' lengths and widths. The patterns of communication between sides were compared statistically. The most typical communication pattern at the sinuses' confluence was a right-dominant TS groove (82.98%). The mean angulations of the entire left TS groove at two different points (A and B) were 46° and 43°. Those of the right TS groove were 44° and 45°. The median angulations of the left and right SSS-transverse sinus junction grooves were 127° and 124°. The mean angulations of the left and right TS-SSJsv grooves were 111° (range 82°-152°) and 103° (range 79°-130°). Differentiating normal and abnormal angulations of the DVSs of the posterior cranial fossa can help to explain why some patients are more susceptible to pathologies affecting the DVSs, such as CVST and VSS. Future application of these findings to patients with such pathologies is now necessary to extrapolate our results.

Eclipse balloon-assisted straight sinus thrombectomy: A novel technique.

Cerebral venous sinus thrombosis comprises 0.5% of all strokes and usually affects young adults. Straight sinus involvement is relatively rare, and it is associated with poor prognosis. Intravenous anticoagulation is considered the first line of treatment. Endovascular approaches such as direct catheter thrombolysis, balloon-assisted thrombolysis, and mechanical thrombectomy may be more efficient and should be considered in cases in which there is involvement of the deep venous system, declining neurological status, or less invasive treatment options have failed. In this work, we describe a novel technique of ECLIPSE 2L balloon (Balt, Irvine, CA) assisted mechanical thrombectomy for straight sinus thrombosis and a review of dural sinus thrombosis management.

Endovascular stenting for cerebral venous sinus stenosis secondary to meningioma invasion.

Symptomatic intracranial hypertension (IH) due to venous outflow obstruction secondary to dural venous sinus (DVS) tumoral invasion affects up to 3% of intracranial meningioma patients. The literature regarding endovascular therapies of such patients is limited to a few case reports and a recent single-centre case series. We describe our single-centre experience of endovascular therapy in patients with clinically symptomatic IH secondary to DVS meningioma invasion. We performed a retrospective review of clinical and radiological data of all patients with refractory IH and meningiomas invading the DVS who were referred for possible DVS venoplasty and stenting. Seven endovascular procedures in six female patients were done. Presumed secondarily induced lateral transverse sinus stenosis was also stented in four patients as part of the primary intervention. All patients experienced complete symptomatic resolution at 6-month follow-up. Five patients had no symptom recurrence over a mean follow-up period of 3.5 years. One patient with multiple meningiomas developed recurrent IH 2 years following stenting secondary to in-stent tumour re-invasion. This was re-stented with consequent 6 months post-retreatment symptomatic relief at the time of writing. No procedure-related complications occurred. In the setting of DVS stenosis secondary to meningioma invasion, endovascular therapy is a safe and successful therapeutic option with promising mid-term results. The procedure should be considered in cases where complete surgical tumour resection is unlikely or carries a significant risk. If present, secondarily induced stenoses at the lateral ends of the transverse sinuses should also be considered for treatment.