Extrinsic versus intrinsic stenosis as a means of clinical triage for patients with symptomatic dural venous sinus stenosis.

Acute and chronic sinusitis in pediatric patients can lead to a variety of intracranial complications, such as intracranial abscesses (brain abscess, subdural empyema, and epidural abscess), meningitis, and venous sinus thrombosis, which are associated with significant morbidity and mortality. This study aims to improve clinical awareness of pediatric sinogenic intracranial abscesses through case presentations and a literature review. We retrospectively analyzed three pediatric cases (10-13years old) with sinogenic intracranial abscesses treated at our institution between 2024 and 2025. Demographic, clinical, radiological, and operative data were extracted from medical records and imaging studies. A review of relevant literature was also performed to summarize key insights into the pathophysiology, clinical manifestations, diagnosis, and management of this condition. Two girls and one boy were included in the study. All three patients presented with key symptoms of headache and fever. Cranial imaging confirmed intracranial purulent collections (epidural abscess or subdural empyema) secondary to sinusitis. All received intravenous antibiotic therapy, and two underwent combined neurosurgical and otolaryngological interventions. All achieved an uneventful recovery and were discharged without severe sequelae. The literature review identified Streptococcus species as the primary pathogens, with frontal and ethmoid sinus involvement being most common. Concurrent neurosurgical and otolaryngological intervention is recommended to optimize treatment outcomes. Pediatric sinogenic intracranial abscesses demand early recognition through integrated clinical and radiological assessment. Multimodal treatment including targeted antibiotics and timely surgical intervention is critical to improving outcomes and minimizing neurological sequelae.

To determine a practical virtual monoenergetic imaging (VMI) energy range that improves in‑stent lumen assessment and reduces metal‑related artifacts on dual‑energy CT venography (DECT‑CTV) after intracranial venous sinus stenting. Retrospective single‑center study including 10 patients (13 stents) who underwent DECT‑CTV after venous sinus stenting for idiopathic intracranial hypertension or pulsatile tinnitus. VMI series were reconstructed from 40 to 140keV in 10‑keV increments. Two neuroradiologists independently scored in‑stent lumen visibility and beam‑hardening/streak artifacts (5‑point Likert). Quantitative analysis used standardized ROI measurements (3 in‑stent and 2 adjacent out‑of‑stent ROIs per stent per keV) and derived metrics including in‑stent attenuation, background noise, CNR, SNR, and dCT_in-out (in‑stent minus out‑of‑stent attenuation). Qualitatively, both readers preferred intermediate‑high energies (90-100keV) for overall interpretability. Quantitatively, in‑stent attenuation decreased from 1180.7 ± 245.5 HU (40keV) to 112.5 ± 15.7 HU (140keV). Noise and dCT_in-out decreased with increasing energy, whereas CNR decreased with increasing energy. SNR showed no statistically significant differences across energies. For intracranial venous sinus stents on DECT‑CTV, VMI around 90-100keV provided the best perceived balance between lumen accessibility and artifact suppression. Findings require validation in larger cohorts with device‑specific subgroup analyses and complementary artifact indices.

BACKGROUND Iodine-induced sialadenitis (iodine-induced mumps), first described in 1956, has been reported in more than 100 cases in the medical literature. It involves acute swelling of the salivary glands, resembling the effects of the mumps virus, after administration of iodine-containing compounds. It is most commonly observed after iodinated contrast administration, although the exact pathophysiology remains unclear. CASE REPORT A 37-year-old woman underwent a cervical-cerebral angiogram, followed by venous sinus stenting 1 week later for idiopathic intracranial hypertension. Approximately 3 h after the procedure, she developed painful, unilateral swelling of the right parotid and submandibular glands. Because of progressively worsening respiratory distress, she required intubation and mechanical ventilation for 3 days. Imaging confirmed clinically significant soft-tissue swelling. Treatment included corticosteroids and supportive care, which resulted in complete symptom resolution. Allergy testing after discharge revealed selective hypersensitivity to the iopamidol contrast agent, with no reaction to iohexol. CONCLUSIONS This case illustrates a rare but potentially life-threatening instance of iodine-induced mumps in a patient without renal impairment. Most cases are self-limiting, but this report underscores the importance of recognizing airway compromise as a serious complication. Clinicians should maintain a high index of suspicion for this condition when patients present with acute salivary gland swelling after contrast exposure. Increased awareness may guide safer imaging practices and reduce unnecessary diagnostic procedures.

Objective: To explore the clinical characteristics, diagnosis and treatment strategies, and prognosis of pulmonary embolism (PE) complicating childhood rheumatic diseases. Methods: A retrospective case series study was performed on the demographic data, laboratory indicators, imaging features, treatment regimens, and follow-up data of 8 children with rheumatic diseases complicated by PE who were admitted to the Department of Rheumatology and Immunology, Capital Center for Children's Health, Capital Medical University from January 2014 to October 2023. Results: Among the 8 children, there were 4 boys and 4 girls, with an age of 12.0 (7.5, 13.0) years. Among the primary diseases, there were 3 cases of systemic lupus erythematosus, 2 cases of Behçet's disease, 2 cases of Takayasu arteritis, and 1 case of antiphospholipid syndrome. All children developed PE during the active phase of the primary disease. PE was detected at the onset of the primary disease in 3 cases, and the median time from the diagnosis of the primary disease to the development of PE was 10.0 (6.0, 25.0) months in the remaining 5 cases. Fever was present in all 8 children, 4 cases were accompanied by chest tightness, dyspnea, etc., and 2 cases only presented with fever. Laboratory examinations revealed the following results: erythrocyte sedimentation rate was 42.0 (17.0, 78.0) mm/1 h, high-sensitivity C-reactive protein was 12.7 (2.6, 78.7) mg/L, white blood cell count was 9.6 (7.2, 18.7)×109/L; D-dimer was 2.3 (0.9, 6.2) mg/L; and hemoglobin was (109±16) g/L.Imaging examinations revealed that 5 cases had involvement of the bilateral lower pulmonary arteries, 5 cases had peripheral embolism, and 3 cases had central PE. Complications included 3 cases of deep vein thrombosis, 2 cases of intracranial venous sinus thrombosis, and 1 case of mild pulmonary hypertension.In terms of treatment, 7 cases received anticoagulation with heparin followed by warfarin. Immunomodulation was mainly based on glucocorticoids combined with immunosuppressants, and 4 cases were combined with biological agents. The follow-up time of 4.17 (1.75, 7.17) years, the time for complete absorption of PE was 10.5 (6.0, 18.0) months; all 8 children had no target events, with no recurrence or chronic thromboembolic pulmonary hypertension, and the pulmonary artery remodeling was good. Conclusions: PE complicating childhood rheumatic diseases is closely related to the activity of the primary disease. The clinical manifestations are insidious, with fever as the main symptom. Imaging examination is the key to diagnosis.Early adoption of heparin followed by warfarin anticoagulation and glucocorticoids combined with immunosuppressants and (or) biological agents to control the primary disease can achieve a favorable prognosis.

The aim of this study was to evaluate the impact of conscious deep breathing on intracranial venous sinus pressures (VSPs) in awake patients undergoing cerebral venography and venous manometry for suspected cerebral venous congestion (CVC). Authors of this retrospective study conducted a chart review of adult patients who, between 2023 and 2025, had undergone cerebral venography and manometry for high clinical suspicion of CVC and had been instructed to engage in deep breathing after baseline VSP measurement at the torcular Herophili. Both the inspiratory and expiratory phases were standardized to 5 seconds in duration to achieve a rate of 6 breaths/minute. After 5 cycles, torcular pressure measurements were repeated. VSP changes before and after deep breathing were assessed for a fast or slow return to baseline. Statistically significant differences between pressure measurements before and after 5 deep breathing cycles as well as differences in blood pressure measurements before and after diagnostic cerebral venography and manometry were assessed using the paired Wilcoxon signed-rank test. All 28 patients included in the study exhibited a reduction in torcular VSP after 5 deep breathing cycles, with a median pressure change of -2.5 (IQR -2.0, -4.0) mm Hg. The median torcular pressure decreased from 8.5 (IQR 5.75, 12) to 5 (2, 9) mm Hg, a change that was statistically significant (p = 3.5 × 10-6). The majority of patients (92.86%) returned to baseline pressures within 5 seconds of deep breathing cessation, whereas 7.14% showed a prolonged return to baseline (>15 seconds), resolving within 2 minutes. As insights into the mechanisms and effects behind CVC grow, noninvasive therapies that improve venous outflow, such as deep breathing, may be impactful to patients, potentially delaying or even obviating the need for surgical treatments. Where surgery is needed, deep breathing may allow for tighter VSP control. Understanding VSPs may thus improve the medical and surgical management of patients with venopathic intracranial hypertension. More research is needed to understand these phenomena.

The presence of dural venous stenosis in idiopathic intracranial hypertension (IIH) is well recognized. However, the complex interplay between intracranial and extracranial factors contributing to pathological intracranial venous congestion remains poorly understood. In this study, the authors explored venous sinus characteristics in cohorts with elevated central venous pressure (eCVP; ≥ 8 mm Hg) and normal CVP (nCVP; < 8 mm Hg). The authors retrospectively reviewed medical records for adult patients who underwent invasive venography with manometry for a suspected or confirmed diagnosis of IIH between January 2017 and December 2024. Venous dimensions and pressure profiles were compared between eCVP and nCVP cohorts. Ninety-eight patients had recorded CVP measurements. The eCVP group (n = 46) exhibited elevated pressures throughout the venous sinuses compared with the nCVP group (n = 52), but opening pressures (OPs), venous sinus dimensions, and pressure gradients did not differ. Post hoc receiver operating characteristic curve analysis identified an internal jugular vein (IJV) pressure cutoff of ≥ 10.5 mm Hg as predictive of eCVP (sensitivity 65.2%, specificity 88.5%, area under the curve 0.835). Applying this threshold, all 268 patients who underwent cerebral venography with manometry were stratified into having an eCVP or eCVP-like effect (n = 96; IJV ≥ 10.5 mm Hg) versus nCVP-like effect (n = 172; IJV < 10.5 mm Hg) on intracranial venous sinus hemodynamics for a strengthened power analysis. Compared with patients with an nCVP-like effect, patients with an eCVP or eCVP-like effect demonstrated higher lumbar puncture OPs (p = 0.05) and narrower sagittal, transverse, and sigmoid sinuses (all p < 0.05), along with the previously observed elevation of venous pressures throughout the sinuses. Furthermore, scatterplots evaluating the relationship between venous sinus dimensions and pressure gradients, stratified by eCVP and nCVP, revealed delayed onset of pressure gradients with increasing OP, higher pressure gradients, and narrower sinus diameters in patients with eCVP compared with patients with nCVP at similar OPs suggested increased dural venous wall compliance. The authors demonstrate the variability in venous sinus dimensions and pressure gradient profiles with increasing OP, stratified by eCVP versus nCVP. Although eCVP initially protected against gradient development, it ultimately resulted in higher venous pressures, which hindered CSF resorption to a greater extent than nCVP, thereby increasing OP to a greater extent, which eventually resulted in greater stenosis and a higher gradient before plateauing. Patients with eCVP demonstrated more compliant dural venous sinus walls, which could influence long-term effectiveness of stenting and chances of progressive adjacent venous sinus stenosis.

Idiopathic intracranial hypertension (IIH), presenting with blurred vision and papilledema in ophthalmology clinics due to elevated intracranial pressure, faces misdiagnoses like optic neuritis. This study explored clinical and radiological characteristics of IIH patients initially diagnosed in ophthalmology. This study included patients diagnosed with IIH between December 2016 and January 2021 at Henan Eye Hospital’s ophthalmology department. Data on best corrected visual acuity, cranial magnetic resonance imaging, magnetic resonance venography, computed tomography venography, and digital subtraction angiography were collected. The study included 41 patients (82 eyes, 34 females, median age: 38 years, and range 19–62 years). Among them, 13 had intracranial pressure above 400 mmH2O, 20 between 300 and 400 mmH2O, and 8 between 250 and 300 mmH2O. Blurred vision, temporary vision loss, and dizziness or headache occurred in 97.6%, 70.7%, and 65.9% patients. All patients showed bilateral optic disc edema, with 13 cases showing positive relative afferent pupillary defect and 28 negative. Visual acuity was ≥ 1.0 in 31 eyes (37.8%) and 0.6 to 1.0 in 26 eyes (31.7%), while only 5 eyes had normal visual fields. Magnetic resonance imaging showed that 17 patients had empty sella signs; 30 cases (73.2%) showed intracranial venous sinus stenosis on magnetic resonance venography or computed tomography venography. Twelve patients underwent digital subtraction angiography, all showing intracranial venous sinus stenosis. IIH patients initially diagnosed in ophthalmology show varied clinical manifestations lacking specificity. Diagnosis may require multiple disciplines to avoid misdiagnosis.

ObjectiveWe investigated the theoretical optimal venous location for an endovascular seizure detection device using stereo‐EEG (SEEG) data.MethodsSix venous sinus segments from consecutive SEEG patients: anterior, middle, and posterior sagittal sinus (SS‐A, SS‐M, SS‐P), straight sinus, and the ipsilateral/contralateral (relative to primary epileptogenic zone) transverse sinus (ITS, CTS). 25 mm was selected as optimal propagation distance, satisfying two criteria: (1) >80% of seizures propagated to the reference point and (2) >90% of patients had at least one electrode within this range. A sinus was classified as “detecting” a seizure if SEEG contacts within a 25 mm radius showed ictal activity at <5 s, <10 s, or any time from onset. We analyzed data at seizure level (focal‐preserved‐consciousness seizure (FPC), focal‐impaired‐consciousness seizure (FIC), and focal‐to‐bilateral‐tonic‐clonic (FBTCS)) and epilepsy level (temporal/extratemporal (TLE/ETLE)). Multilevel regression and pairwise comparisons were performed to assess detection rates across sinuses.ResultsWe analyzed 113 seizures (FPC: 30.1%, FIC: 50.4%, FBTCS: 19.5%) from 40 patients (TLE: 50%). At the optimal propagation distance, 86.11% of seizures propagated to the reference point. Additionally, 92.5% of seizures were detectable from at least one sinus location at any time point, with an average minimum sinus‐to‐contact distance of 9.38 mm. Seizure level: ITS had the highest seizure detection rate at any time point (FPC: 71.43%, FIC: 95.56%, FBTCS: 100%) and was superior or non‐inferior to other sinuses for FPC and FIC. No significant differences were observed for FBTCS between sinuses. Epilepsy‐level: ITS detected the most seizures at any time point (TLE: 93.75%, ETLE: 82.35%). ITS outperformed other sinuses for TLE, except the straight sinus. For ETLE, only SS‐P was significantly less effective than SS‐M and SS‐A.SignificanceBased upon SEEG seizure propagation modeling, over 90% of seizures were detectable from venous sinus locations, supporting the feasibility of endovascular seizure detection devices. ITS demonstrated a high yield for seizure detection across seizure and epilepsy types.Plain Language SummaryThis study aims to investigate whether seizures can be detected from venous locations and to determine the best placement for endovascular devices. Over 90% of seizures were detectable within 25 mm of the venous sinus, supporting the feasibility of this approach. The most effective venous sinus depended on the type of seizure and epilepsy. The transverse sinus on the same side as the seizure origin (ipsilateral transverse sinus, ITS) showed the highest overall potential for seizure detection. Sagittal sinus‐middle (SS‐M) was the best for detecting focal‐preserved‐consciousness seizures, while ITS and straight sinus were the best for detecting focal‐impaired‐consciousness seizures.

Dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous shunts that occur between intracranial arteries and venous sinuses, meningeal veins, or cortical veins. These lesions can lead to pathological changes such as cerebral edema, increased intracranial pressure, metabolic dysfunction in the brain, venous sinus thrombosis, and vascular rupture with hemorrhage. Clinically, DAVFs rarely present as Parkinsonism, often coexisting with dementia. While there are numerous global reports of DAVF with cognitive impairment as the primary symptom, cases of DAVF presenting predominantly with Parkinsonism are exceedingly rare. Secondary Parkinsonism in DAVF may be associated with deep venous reflux and venous hypertension involving the basal ganglia. Severe dementia symptoms may overshadow Parkinsonian features, complicating the clinical diagnosis of DAVF-induced Parkinsonism. This article aims to review published case reports and series to summarize the clinical and imaging characteristics (CT, MRI, and angiography) of these patients, evaluate the quality of the cases, and hypothesize potential pathophysiological mechanisms, providing clinical guidance for the management of DAVF-associated Parkinsonism.

The transfemoral approach has traditionally been the primary access site for catheter-guided venography. Recently, upper extremity transvenous access (UETV) has emerged as a promising alternative for neurointerventional procedures, offering potential advantages such as reduced bleeding risk, improved ergonomics, faster recovery, shorter procedure and fluoroscopy times, and a lower likelihood of inadvertent arterial puncture. This study reports on a single-center experience of UETV for neurointerventional venous therapy. A total of 158 diagnostic venograms and venous interventions were performed by a single operator between 2020 and 2024 at a single center, with primary intent to use the upper extremity veins for venous access. Data on patient demographics, procedural details, radiographic findings, and outcomes were collected and analyzed. Out of 158 procedures, successful upper extremity catheterization was achieved in 155 cases (98.1%), with 149 (94.3%) completed successfully. Conversion to a femoral approach was necessary in 3 cases (1.9%), all of which were completed successfully. Six interventions (3.8%) were aborted due to challenges in navigating the intracranial veins and venous sinuses that were unrelated to peripheral access. Minor complications occurred in 8 patients (5.1%); no major complications were observed. This single-center study demonstrates the feasibility and safety of upper extremity-only transvenous access for neurointerventional procedures in the management of complex cerebrovascular diseases. The cephalic and basilic veins of the antecubital fossa veins are recommended as primary access sites. These findings represent the largest case series to date using an upper extremity-first transvenous approach for neurointerventional therapy.

To determine the prevalence of papilledema among patients referred for suspected papilledema and identify symptoms associated with increased intracranial pressure. This retrospective study included 514 patients referred to the ophthalmology clinic with suspected papilledema. Patient records were reviewed for demographic details, symptoms, and diagnostic outcomes. Examinations included best-corrected visual acuity (BCVA) assessments, fundoscopic evaluations, visual field (VF) tests, optical coherence tomography (OCT)-retinal nerve fiber layer (RNFL) thickness and fundus photographs. The rates of detected papilledema and pseudopapilledema, along with associated symptoms, were evaluated. Of 514 patients, papilledema was diagnosed in 109 cases (21.2%). Idiopathic intracranial hypertension was the most common etiology (n = 91), yet cases with serious underlying causes, such as intracranial tumors (n = 5) and cerebral venous sinus thrombosis (n = 5), were also identified. Headache was a frequent symptom but showed no significant correlation with papilledema (p = 0.653), while transient visual obscurations (TVOs) demonstrated a strong association (p < 0.001). Among papilledema patients, 33 had full BCVA, and 37 had a VF MD of - 2dB or better. Abnormal VF (MD worse than - 2dB) was found in 36.4% of patients with full BCVA. It was observed that the RNFL thickness in all quadrants was greater in the papilledema group compared to the healthy optic disc group. Pseudopapilledema, present in 20 patients (3.9%), was frequently due to optic disc drusen. There were no statistically significant differences in symptoms between patients with papilledema and those with pseudopapilledema. Papilledema screening is a common consultation, particularly in the presence of accompanying symptoms, and accurate evaluation is crucial, especially for patients presenting with TVOs. Abnormal VFs were detected in patients with normal BCVA, most commonly presenting as an enlarged blind spot. This highlights that BCVA alone is insufficient for diagnosing and monitoring suspected papilledema. Recognizing papilledema is vital given its association with conditions carrying significant morbidity and mortality risks, such as intracranial tumors and thrombosis. Enhanced ophthalmoscopy skills among referring physicians may streamline the referral process, reduce unnecessary consultations, and improve patient outcomes by enabling timely intervention for high-risk cases.

Venous sinus-occlusive mass lesions are infrequent and commonly include meningiomas, with Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) being much less common. The authors present a case report of a venous sinus-occlusive EBV-SMT in an adolescent immunosuppressed male after liver transplantation. The case highlights the importance of considering blood flow dynamics and the use of advanced imaging modalities including incident dark field microcirculation microscopy and indocyanine green video angiography when managing venous sinus-occlusive mass lesions. To the best of the authors' knowledge, this is the first report of a primary intracranial venous sinus EBV-SMT occurring in an HIV-negative patient after liver transplantation, and it illustrates management dilemmas of a sinus-occlusive tumor at a sensitive region of the superior sagittal sinus. https://thejns.org/doi/10.3171/CASE24759.

To summarize the clinical characteristics, diagnosis, and treatment outcomes of neonatal venous thrombosis. A retrospective analysis was conducted on the clinical data of 11 neonates with venous thrombosis admitted to the Department of Neonatology of Anhui Children's Hospital from January 2019 to September 2024. The clinical characteristics, diagnostic approaches, treatments, and outcomes were analyzed. Among the 11 neonates diagnosed with venous thrombosis, 5 were male, and 6 were preterm infants, with a median gestational age of 35+6 weeks, birth weight of (2 322±1 069) g, and admission temperature of (36.6±0.4)°C. The median age at symptom onset was 6 days. Of the 11 cases, 8 limb venous thromboses and 1 portal vein thrombosis were confirmed by vascular ultrasound, and 2 cases of intracranial venous sinus thrombosis were confirmed by magnetic resonance imaging. Ten cases received low molecular weight heparin for anticoagulation, with a treatment duration of (24±15) days; 2 cases were treated with urokinase thrombolysis, and 4 cases received fresh frozen plasma transfusion. Thrombosis resolved in 7 cases before discharge. Partial resolution occurred in 2 cases before discharge (1 continued outpatient treatment until resolution and 1 resolved during follow-up). One case was transferred to another hospital after 1 day of treatment and was discharged after thrombosis reduction. No adverse reactions such as bleeding were observed. One neonate with cerebral infarction at admission did not receive heparin anticoagulation and was followed up as an outpatient. Vascular ultrasound is the most commonly used diagnostic method for neonatal venous thrombosis. Heparin anticoagulation is the recommended treatment. The overall prognosis of neonatal venous thrombosis is favorable.

Idiopathic intracranial hypertension (IIH) and venous sinus stenosis have recently been implicated in the pathogenesis of encephaloceles. Here, the authors present 2 cases in which venous sinus stenting was crucial for symptom management either after surgical repair of an encephalocele or as a stand-alone treatment. Venous sinus stenting is emerging as a novel treatment option in the management of encephaloceles associated with IIH. https://thejns.org/doi/10.3171/CASE24855.

The posterior condylar canal (PCC) is a crucial structure facilitating venous drainage from the intracranial venous sinuses to the extracranial system. This study was aimed at providing anatomical insights into the PCC's prevalence, and the location and diameter of the extracranial and intracranial orifices, with the goal of aiding surgical procedures involving the posterior skull base, foramen magnum, and jugular foramen. Two hundred dry skulls (100 male and 100 female) were examined. The PCC was traced using a flexible wire through its extracranial orifice. Its location was categorised relative to the posterior edge of the occipital condyle (PEOC) into lateral, middle, or medial thirds. The intracranial orifice was classified as intrajugular, intrasinus, or retrosinus. The maximum diameter of the extracranial orifice was measured. The PCC was present in 79.5% of skulls, with bilateral occurrence in 39.5%, right unilateral in 22%, and left unilateral in 18%. In 20.5% of cases, the PCC was absent. A double PCC was observed in a single skull. No statistically significant difference in PCC prevalence was found between sexes. The extracranial orifice was most commonly located in the lateral third of the PEOC (41.4%). The most prevalent intracranial orifice type was intrajugular (46.6%). The average PCC diameter was 3.77 ± 1.0 mm. No statistically significant difference was observed between sides in either extracranial location or intracranial orifice type. Understanding the anatomical variations of the PCC is clinically important for radiologists in interpreting pathological conditions, and for neurosurgeons in planning surgeries involving the occipital condyle region.

ObjectiveTo evaluate the effectiveness of the variable rate bolus tracking technique combined with third-generation dual-source CT dual-energy scanning in enhancing the quality of head and neck vascular CT angiography (CTA).MethodsWe conducted a retrospective analysis of 202 patients who underwent head and neck vascular CTA using a third-generation dual-source CT with dual-energy scanning. Patients were divided based on the contrast injection method into two groups: the variable-rate bolus tracking group (Group A, n = 100) and the fixed flow rate group (Group B, n = 102). We compared subjective image quality, venous artifacts, and objective image quality parameters between the two groups.ResultsThe amount of contrast agent used in Group A was significantly lower than in Group B. Additionally, mean attenuation values of arterial segments in Group A were markedly lower than those in Group B. Compared to Group B, attenuation values of the intracranial venous sinuses, right jugular vein, superior vena cava, right subclavian vein, and left jugular vein in Group A showed significant reductions. No significant difference was observed in the subjective image quality between the two groups. However, venous artifact in the right subclavian vein was significantly diminished in Group A.ConclusionThe application of the variable rate bolus tracking technique alongside third-generation dual-source CT dual-energy scanning in head and neck vascular CTA can achieve high-quality imaging while reducing contrast agent dosage. It enhances the attenuation contrast of intracranial arteries and veins and minimizes residual contrast and artifacts in the right subclavian vein.

BackgroundEndovascular stenting is a promising treatment for patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS). However, data on the impact of stenosis type on clinical outcomes of...

BackgroundThe River stent is the first stent specifically designed for intracranial venous sinuses. We report the 1-year results of the River trial, performed to obtain Humanitarian Device Exemption approval of...

Abstract The vascular system regulates brain clearance through arterial blood flow and lymphatic drainage of cerebrospinal fluid (CSF). Idiopathic intracranial hypertension (IIH), characterized by elevated intracranial pressure and dural venous sinus stenoses, can be treated by restoring venous blood flow via venous stenting, suggesting a role for venous blood flow in brain fluid clearance. Using magnetic resonance imaging (MRI) in IIH patients and healthy controls, we identified that dural venous stenoses in IIH were associated with impaired lymphatic drainage, perivenous fluid retention, and brain fluid accumulation. To investigate this further, we developed a mouse model with bilateral jugular vein ligation (JVL), which recapitulated key human findings, including intracranial hypertension, calvarial lymphatic regression, and brain swelling due to impaired clearance. To further dissect the respective roles of meningeal lymphatic vessels and venous blood flow in brain clearance, we performed JVL in mice with lymphatic depletion. These mice exhibited spontaneous elevated intracranial pressure, but JVL did not further exacerbate this effect. Moreover, the synchronous restoration of brain clearance and meningeal lymphatics observed in mice after JVL was absent in lymphatic-deficient mice.Transcriptomic analyses revealed that lymphatic remodeling induced by JVL was driven by VEGF-C signaling between dural mesenchymal and lymphatic endothelial cells. These findings establish the dural venous sinuses as a critical platform where venous blood flow interacts with mesenchymal cells to preserve meningeal lymphatic integrity and function, essential for brain fluid clearance.