Venous Sinus Stenosis Research Articles

Analysis of Revision Surgery Following Surgical Reconstruction of the Sigmoid Sinus Wall in Patients with Pulsatile Tinnitus.

Background:To explore potential causes leading to the failure of the surgical reconstruction of sigmoid sinus wall in patients with pulsatile tinnitus.Methods:This study retrospectively analyzed pulsatile tinnitus patients with sigmoid sinus wall dehiscence and/or sigmoid sinus diverticulum, who underwent revision surgeries following the surgical reconstruction of the sigmoid sinus wall.Results:A total of 7 pulsatile tinnitus patients were included. After the first surgery, 5 of 7 patients showed varying degrees of remission in pulsatile tinnitus, but pulsatile tinnitus gradually recurred. The other 2 patients experienced no change in pulsatile tinnitus. Images after the first surgeries revealed that the surgical failure of Patients 1-5 was caused by incompleted elimination of sigmoid sinus wall dehiscence and sigmoid sinus diverticulum. Following revision surgeries, they all acquired great or complete resolution of pulsatile tinnitus. In Patient 6, an abnormal diploic vein entering the sigmoid sinus was overlooked during the first surgery for repairing sigmoid sinus wall dehiscence. As soon as the diploic vein was blocked during the revision surgery, the patient’s pulsatile tinnitus was alleviated significantly. Patient 7 had a recurrence of pulsatile tinnitus after transient improvement following the first surgery, and still experienced no change in pulsatile tinnitus after the revision surgery. However, after venous sinus stenting in the stenosis of transverse-sigmoid sinus junction, she got complete resolution of pulsatile tinnitus. It suggested that the unresolved stenosis of the venous sinus was the cause of the surgical failure.Conclusions:Both sigmoid sinus diverticulum and sigmoid sinus wall dehiscence are recommended to be resolved during surgery. Abnormal diploic veins and venous sinus stenosis are potential causes of pulsatile tinnitus.

Idiopathic intracranial hypertension imaging approaches and the implications in patient management.

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.

不同引流静脉类型对支架治疗特发性颅内高压合并静脉窦狭窄疗效的影响 Effect of Different Intracranial Venous Drainage Patterns on Stenting for Idiopathic Intracranial Hypertension with Venous Sinus Stenosis

不同引流静脉类型对支架治疗特发性颅内高压合并静脉窦狭窄疗效的影响 Effect of Different Intracranial Venous Drainage Patterns on Stenting for Idiopathic Intracranial Hypertension with Venous Sinus Stenosis

Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension-From Physiopathology to Treatment.

In this review, we provide an update on the pathogenesis, diagnosis, and management of adults with idiopathic intracranial hypertension (IIH) and implications of the cerebral venous system, highlighting the progress made during the past decade with regard to mechanisms of the venous outflow pathway and its connection with the cerebral glymphatic and lymphatic network in genesis of IIH. Early diagnosis and treatment are crucial for favorable visual outcomes and to avoid vision loss, but there is also a risk of overdiagnosis and misdiagnosis in many patients with IIH. We also present details about treatment of intracranial hypertension, which is possible in most cases with a combination of weight loss and drug treatments, but also in selected cases with surgical interventions such as optic nerve sheath fenestration, cerebral spinal fluid (CSF) diversion, or dural venous sinus stenting for some patients with cerebral venous sinus stenosis, after careful analysis of mechanisms of intracranial hypertension, patient clinical profile, and method risks.

Safety and efficacy comparison between OACs plus single antiplatelet and dual antiplatelet therapy in patients with cerebral venous sinus stenosis poststenting

Background and purposeThe present strategies regarding poststent management for cerebral venous sinus stenosis (CVSS) are inconsistent. Herein, we compared the safety and efficacy of oral anticoagulants (OACs) plus single antiplatelet therapy and dual antiplatelet therapy for CVSS poststenting.MethodsA real-world observational study conducted from January 2009 through October 2019 enrolled patients who were diagnosed with CVSS and received stenting. Patients were divided into two groups according to the management they received poststenting. Group 1: OACs plus a single antiplatelet agent (clopidogrel 75 mg or aspirin 100 mg) and Group 2: dual antiplatelet therapy (clopidogrel 75 mg plus aspirin 100 mg). The safety (such as major or minor bleeding or venous thrombosis) and efficacy (the incidences of cerebral venous sinus restenosis, intrastent thrombosis, or stent displacement) of the two groups were compared.ResultsThere were a total of 110 eligible patients in the final analysis, including 79 females and 31 males with a mean age of 43.42 ± 13.23 years. No major bleeding or venous thrombosis occurred in either of the two groups. Two minor bleeding events occurred in group 2 (one with subcutaneous bleeding points in both lower limbs, another with submucosal bleeding in the mouth), whereas no bleeding events occurred in Group 1. In addition, at the 1-year follow-up, one case of intraluminal restenosis and two cases of in-stent thrombi occurred in Group 2, while none occurred in Group 1. Neither stenosis at stent-adjacent segments nor stent migration was detected in either group during the 1-year following stent placement.ConclusionOACs plus single antiplatelet therapy and dual antiplatelet therapy alone are both safe and efficacious management strategies after CVSS stent placement. The former may have more advantages than the latter for inhibiting intrastent thrombosis. However, further research by larger, multicenter clinical trials is needed.

Emergence of Venous Stenosis as the Dominant Cause of Pulsatile Tinnitus

Background The role of arteriovenous shunts such as dural fistulas, arterial steno‐occlusive states, anatomic variants, and hypervascular tumors in the genesis of pulsatile tinnitus (PT) has long been recognized. On the venous side, diverticula, high‐riding jugular bulb, and sinus wall dehiscence have also been implicated. However, the overall most common cause—venous sinus stenosis (VSS)—continues to be underrecognized. Its clinical importance, separate from venous stenosis association with intracranial hypertension, also requires emphasis. Methods A retrospective review of the last consecutive 208 cases of PT seen at our institution was performed and cause determined, when possible, based on clinical and radiographic data. Results VSS was the common cause of PT (34% of overall cohort). Over 90% are women. Typical clinical presentation was a unilateral whoosh‐like sound in sync with heartbeat that could be completely or nearly completely abolished by ipsilateral jugular compression. This clinical scenario virtually guaranteed the presence of VSS, with very high sensitivity, specificity, positive, and negative predictive values. About two thirds of patients with VSS also harbored other venous anatomic variations such as a high‐riding jugular bulb or sinus diverticulum, that should not be misinterpreted as the primary cause of PT. Most did not have signs or symptoms of intracranial hypertension, even though cerebrospinal fluid and venous pressures are frequently elevated. Conclusions VSS appears to be the most common identifiable cause of PT. Judicious attention to this finding can be immensely helpful in prompt and accurate diagnosis.

Association of post-intervention pressure gradient with symptom-free at 6 months in idiopathic intracranial hypertension with venous sinus stenosis treated by stenting.

This study aimed to identify the key factors that might affect the clinical outcome of patients with idiopathic intracranial hypertension (IIH) and Venous sinus stenting (VSS). We performed an analysis of a prospectively collected database of patients with IIH and VSS who underwent stenting. The trans-stenotic pressure gradient was measured before and after intervention. In additional, patients' baseline characteristics, procedure details and clinical outcomes at 6-month follow-up (including changes in headache, visual impairment, papilledema, etc.) were recorded. The effects of post-intervention pressure gradient on symptom-free at 6 months were explored using logistic regression analysis, generalized additive model and receiver operator characteristic (ROC) curve. Of 101 patients included in this study, the median pressure gradient across stenosis decreased from 19 mmHg before intervention to 2 mmHg after intervention. At 6 months, symptom-free was observed in 58 cases (57.4%). Multivariable logistic analysis and generalized additive model showed that post-intervention pressure gradient (increased by 1 mmHg) was independently and linearly correlated with symptom-free (OR = 0.79, 95% CI = 0.67-0.94). Moreover, the post-intervention pressure gradient revealed moderate discrimination with an area under ROC curve of 0.68 (95% CI = 0.57-0.78). Similar associations were observed for the disappearance of headache and papilledema, but not for the visual recovery. The post-intervention pressure gradient may be a valid and reliable predictor of 6-month clinical outcome in patients with IIH and VSS treated by stenting. Nevertheless, external validation with blinded outcome is still needed to confirm its performance before clinical application.

Advances in the Understanding of the Complex Role of Venous Sinus Stenosis in Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated intracranial pressure (ICP) that predominantly affects young obese women. IIH is a diagnosis of exclusion. That is, if increased ICP is suspected, magnetic resonance imaging and magnetic resonance venography of the brain are recommended to exclude secondary causes. Imaging findings, such as empty sella, orbital findings, meningocele, and encephalocele, are not diagnostic of ICP, nor does their absence exclude ICP either. Therefore, venous manometry is recommended as the gold standard for evaluation, regardless of previous anatomic imaging results. Venous manometry is an invasive examination that is frequently applied to derive physiologic information concerning the nature of the pressure gradient. However, the pathogenesis of IIH has not been fully elucidated. The presence of venous sinus stenosis in a subset of patients has provided some support for the potential mechanisms underlying this condition. Hence, this review provides an up‐to‐date discussion on the potential pathogenic mechanisms of IIH with a special focus on venous sinus stenosis.Level of Evidence1Technical Efficacy Stage2

Morphometric Measurements of the Superior Sagittal, Transverse and Sigmoid Dural Venous Sinuses in Normal Cerebral MRV Images of Adult Bangladeshis

Background: The dural venous sinuses show different types of morphometric variations in their anatomy as well as involvement with various neurological conditions like cerebral venous sinus thrombosis, venous sinus stenosis, embolism, fistula etc. Cerebral MRV (Magnetic Resonance Venography) is a well-established radiological technique to visualize the dural venous system. By measuring the sinus dimensions in cerebral MRV images and calculating the indices, morphometric variations of the dural venous sinuses can be identified which is essential for diagnosing different pathologies of the dural venous system. Researcher have detected most of the variations in the superior sagittal, transverse and sigmoid venous sinuses. Objectives: To develop anatomical baseline data on morphometric measurements of the dural venous sinuses in normal cerebral MRV images of adult Bangladeshis. Methods: The research was cross-sectional and observational in nature. It was carried out in the Department of Anatomy, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with the Department of Neuroradiology & Imaging, National Institute of Neuroscience and Hospital (NINS), Dhaka, from March 2020 to June 2021. Adults (35 males and 35 females) aged 18 years or above who attended in the Department of Neuroradiology & Imaging, NINS for cerebral MRV and diagnosed as having normal dural venous sinuses without any pathology by a registered Neuroradiologist were the participants of this research. The MRV scans were produced by using 3 Tesla magnetic field strength following the routine standard protocols of the institution. By using the Radiant DICOM Viewer software, a total of 9 linear and curvilinear dimensions were measured and 2 indices were calculated by the researcher and the co-investigator independently to reach consensus on each variable. Results: A numerical data set was generated on the morphometric measurements of the superior sagittal, transverse and sigmoid sinuses ......

Brain herniation (encephalocele) into arachnoid granulations: prevalence and association with pulsatile tinnitus and idiopathic intracranial hypertension

PurposeBrain herniation into arachnoid granulations (BHAG) of the dural venous sinuses is a recently described finding of uncertain etiology. The purpose of this study was to investigate the prevalence of BHAG in a cohort of patients with pulsatile tinnitus (PT) and to clarify the physiologic and clinical implications of these lesions.MethodsThe imaging and charts of consecutive PT patients were retrospectively reviewed. All patients were examined with MRI including pre- and post-contrast T1- and T2-weighted sequences. Images were reviewed separately by three blinded neuroradiologists to identify the presence of BHAG. Their location, signal intensity, size, presence of arachnoid granulation, and associated dural venous sinus stenosis were documented. Clinical records were further reviewed for idiopathic intracranial hypertension, history of prior lumbar puncture, and opening pressure.ResultsTwo hundred sixty-two consecutive PT patients over a 4-year period met inclusion criteria. PT patients with BHAG were significantly more likely to have idiopathic intracranial hypertension than PT patients without BHAG (OR 4.2, CI 1.5–12, p = 0.006). Sixteen out of 262 (6%) patients were found to have 18 BHAG. Eleven out of 16 (69%) patients had unilateral temporal or occipital lobe herniations located in the transverse sinus or the transverse-sigmoid junction. Three out of 16 (19%) patients had unilateral cerebellar herniations and 2/16 (13%) patients had bilateral BHAG.ConclusionIn patients with PT, BHAG is a prevalent MRI finding that is strongly associated with the clinical diagnosis of IIH. The pathogenesis of BHAG remains uncertain, but recognition should prompt comprehensive evaluation for IIH.

Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension.

Venous sinus stenosis (VSS) stenting has emerged as an effective treatment for patients with Idiopathic Intracranial Hypertension (IIH). However, stenting carries risk of in-stent stenosis/thrombosis and cumulative bleeding risk from long-term dual antiplatelet (DAPT) use. Thus, we investigated the potential safety and efficacy of primary balloon angioplasty as an alternative to stenting in IIH. A prospectively maintained single-center registry of IIH patients undergoing endovascular procedures was queried. Inclusion criteria included patients with confirmed IIH and angiographically demonstrable VSS who underwent interventions from 2012- 2021. Patients were dichotomized into primary balloon angioplasty (Group A) and primary stenting (Group S), comparing clinical outcomes using bivariate analyses. 62 patients were included with median age of 33 [IQR 26-37], 74% females. Group A (9/62) and Group S (53/62) had similar baseline characteristics. Papilledema improvement was higher in Group S at 6 weeks and 6 months (44 vs. 93, p = 0.002 and 44 vs. 92%, p = 0.004), with similar improvements across all symptoms. Group S had higher mean post-procedure venous pressure gradient change (8 vs. 3 mmHg, p = 0.02) and a lower CSF opening pressure at 6 months (23 vs. 36 cmH2O, p < 0.001). VPS rescue rate was higher in Group A (44 vs. 2%, p = 0.001). There was only one procedural complications; a subdural hematoma in Group A. Primary VSS balloon angioplasty provides a marginal and short-lived improvement of IIH symptoms compared to stenting. These findings suggest a cautious and limited role for short-term rescue angioplasty in poor shunting and stenting candidates with refractory IIH.

Venous sinus stenting after repair of skull base spontaneous cerebrospinal fluid leaks: a single-center retrospective cohort series with case-control analysis

Managementof idiopathic intracranial hypertension (IIH) is recommended after surgical repair of spontaneous cerebrospinal fluid leaks (sCSF-leaks) of the skull base for prevention of recurrence.Purpose: To assess the feasibility of venous sinus stenting, a treatment commonly used for the treatment of IIH associated with intracranial venous sinus stenosis (VSS), after sCSF-leaks closure. Asingle-center cohort series of consecutive patients who underwent sCSF-leak closure was retrospectively analyzed. Stenting was considered either for leak recurrence or in prophylactic manner after repair in patients with VSS as confirmed by cerebral venous imaging. Leak recurrence, need for new repair or adjunctive treatment of IIH, meningitis, and stenting complications were determined at the last follow-up. Cases who had prophylactic stenting were compared to historical controls before stenting option. Twenty-twopatients had intracranial venous stenting after sCSF-leak closure. Their median age was 58 years (Q1=45; Q3=68), BMI=31 kg.m-2 (Q1=27; Q3=36), and female rate=85%. The overall rate of successful repair after stenting was 95% (95% CI = 87-100%) at a median follow-up of 2.4 years (Q1=1.2; Q3=3.3). Adjunctive treatment for IIH was needed in 4 patients (4/22, 18%) including 2 patients without leak recurrence. No meningitis, permanent morbidity or mortality was observed after stenting. Compared to 18 controls, cases had significantly less recurrence (P = 0.03), and a trend for less adjunctive treatment for IIH (P = 0.06). Our study suggests that stenting might be a valid option for prevention of sCSF-leak recurrences after repair in patients with intracranial venous sinus stenosis. Déclaration de liens d'intérêts Les auteurs n'ont pas transmis leur déclaration de liens d'intérêts.

A survey on the effect of adding aspirin to anti-migraine drugs on the severity of headache in patients with chronic migraine headaches with lateral venous sinus stenosis in MRV.

One of the probable etiologies raised in patients with chronic migraine headaches is stenosis of the lateral venous sinuses of the brain, which is detectable using magnetic resonance venography (MRV). In this study, we decided to observe the effect of adding aspirin to anti-migraine medicines on the severity of headache in patients with chronic migraine headaches with lateral venous sinus stenosis in MRV. The study was a double-blind randomized clinical trial. Patients were included in the study in two groups including 30 people. The first group was treated with propranolol and nortriptyline, and the second group was treated with propranolol, nortriptyline, and aspirin. The severity of headache, number of headaches during one month, and duration of a headache before treatment and one, two, and three months after treatment were examined. Data were analyzed utilizing SPSS software version 19 and statistical tests like t-test, Chi-squared test, Paired t-test, and repeated measure. The results showed that the mean severity of headache in the second group was significantly lower than the first group two months after treatment (P = 0.003) and three months after treatment (P = 0.002). Additionally, the number of headaches (P = 0.001) and duration of headache (P = 0.043) were significantly lower in the second group than the first group in the first three months after treatment. No statistically significant difference was observed between the frequency distribution of nausea/vomiting in the two groups. The addition of aspirin to anti-migraine medicines is effective in improving the severity of headache in patients with migraine with lateral venous sinus stenosis of the brain.

Reversal of Intracranial Hypertension‐Related Pseudomeningocele after Venous Sinus Stenting

Postoperative pseudomeningocele is a common complication of craniotomies for tumor resection. Intracranial hypertension can hinder dural repair and potentially lead to refractory or severe cases of pseudomeningocele. We present an unconventional use of venous sinus stenosis stenting to treat postcraniotomy pseudomeningocele driven by intracranial hypertension.

Anatomic Variation of the Lateral Sinus in Patients With Idiopathic Intracranial Hypertension: Delineation With Black-Blood Contrast-Enhanced MRI.

Objectives: The purpose of this study was to describe the peculiar anatomic variations in the lateral sinus and analyze the patterns of cerebrospinal fluid (CSF) drainage by using high-resolution (HR) black-blood (BB) contrast-enhanced magnetic resonance imaging (MRI) in patients with idiopathic intracranial hypertension (IIH).Methods: Total 33 IIH patients who were found cerebral venous sinus stenosis (CVSS) by MR venography (MRV) were enrolled in this study. HR-BB contrast-enhanced MRI was used to assess the features of anatomical variations in transverse sinus and sigmoid sinus. The development of bilateral sinuses was firstly evaluated, including unilateral hypoplasia with contralateral dominance or bilateral balanced development. Then, four kinds of anatomical variations were eventually recorded, including circumscribed stenosis, arachnoid granulation (AG), fibrous septum (FS), and brain herniation (BH) into dural venous sinus (DVS).Results: Bilateral venous drainage dysfunction was found in 30(90.9%) patients, whereas only 3(9.1%) patients presented unilateral venous drainage dysfunction. There was no difference in clinical symptoms between the two groups. The most common case is hypoplasia in unilateral sinus combined with anatomic variation in the contralateral dominant transverse sinus such as AG and BH into DVS. Total of 52 anatomic variations were finally found in bilateral sinuses in 33 enrolled patients, including 19(36.5%)AGs, 12(23.1%)FS, 7(13.5%) BH into DVS and 14(26.9%) circumscribed stenoses. Moreover, 41(62.1%) lateral sinuses showed enhancement in T1-weight-enhanced MRI.Conclusions: Patients with CVSS almost had CSF outflow disorders, whatever bilateral equalization or unilateral hypoplasia with contralateral dominance. Four types of main anatomic variations, including circumscribed stenosis, AG, FS, and BH into DVS, caused venous reflux obstruction by elevating the intracranial press (ICP).

Characteristics and Outcomes of the Idiopathic Intracranial Hypertension Treatment in Intrinsic and Extrinsic Stenosis: A Single-Center Experience in China.

IntroductionThis study aimed to explore the precipitating factors and evaluate the impact of different stenosis types on treatment outcomes in patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS).MethodsWe recruited patients with IIH who presented with VSS, either intrinsic or extrinsic. We observed the clinical and laboratory findings, and we then compared the outcomes of stenting and medical treatment in different stenosis types.ResultsAmong 145 patients with IIH and VSS, 59 were of the intrinsic type and 86 were of the extrinsic type. Patients in the intrinsic group were older (42 vs. 34 years old, P < 0.001) and presented with higher pre-op gradient pressure (15 mmHg vs. 12 mmHg, P < 0.001). There was no significant difference between groups regarding other precipitating factors (P > 0.05). Stenting was significantly associated with complete resolution of the headache and impaired vision both in intrinsic (adjusted OR 0.017, 95% CI 0.001–0.35, P = 0.011; adjusted OR 0.056, 95% CI 0.004–0.697, P = 0.025, respectively) and extrinsic types of stenosis (adjusted OR 0.072, 95% CI 0.015–0.343, P = 0.001; adjusted OR 0.241, 95% CI 0.062–0.931, P = 0.039, respectively). Meanwhile, stenting was significantly associated with improvement of the papilledema in extrinsic-type stenosis compared with medical treatment (adjusted OR 0.017, 95% CI 0.002–0.135, P < 0.001).ConclusionStenting may provide substantial clinical improvement in patients with IIH regardless of intrinsic or extrinsic stenosis type in our patient population, as noted in other series.Trial RegistrationClinical trial registration number ChiCTR-ONN-17010421.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40120-021-00281-0.

Investigation of the Prevalence of Cerebral Transverse Venous Sinus Stenosis in Idiopathic Intracranial Hypertension

Purpose: Idiopathic intracranial hypertension (IIH) is an increase in intracranial pressure with a normal cerebrospinal fluid (CSF) composition that is not due to a secondary cause. The existence of cerebral transverse venous sinus stenosis and changes in venous outflow in IIH has recently gotten a lot of attention, and this situation is becoming increasingly important in terms of diagnosis and treatment plan. &#x0D; This study aimed to investigate how frequent cerebral transverse venous sinus stenosis is in patients with IIH. &#x0D; Methods: The demographic profile of 27 patients with IIH who were followed up in the hospital's neurological headache outpatient clinic and the occurrence of cerebral transverse venous stenosis on cranial magnetic resonance venography (MRV) were studied. Considering the pre-diagnosis of cerebral venous thrombosis (SVT), patients who underwent magnetic resonance venography (MRV) and whose SVT was ruled out during their follow-up were included as the control group. This control group consisted of 48 patients diagnosed with migraine, tension-type headache (TTH), and new-onset daily persistent headache.&#x0D; Results: When MRVs were investigated, cerebral transverse venous sinus stenosis was detected in %55.6 (n=15) of IIH patients and 25% (n=12) of the control group (p = 0.017).&#x0D; Conclusions: The frequency of cerebral transverse sinus stenosis in MRV of patients diagnosed with IIH was found to be significantly higher in this study than in the control group. These findings indicated that cerebral transverse venous stenosis can play a role in the progression of IIH.

Predictors of cognitive impairment in pseudotumor cerebri.

We aimed to define the cognitive burden of the largest pseudotumor cerebri syndrome (PTCS) population to date, compare objective to subjective cognitive dysfunction, and determine clinical predictors of cognitive dysfunction amongst an array of previously unstudied factors. Patients with PTCS commonly report cognitive dysfunction, a factor associated with poor quality of life. It is not definitively known whether cognitive impairment is present in these patients, and what features of the syndrome predict impairment. We administered a cognitive battery consisting of the National Adult Reading Test, Mini-Mental Status Exam, Digit Span, Boston Naming Test, Rey Auditory Verbal Learning Test, Clock Drawing, Trail Making Test, Controlled Oral Word Association, and Category Fluency. Cognitive impairment was defined as mild-single domain with one test score, and mild-multiple domain with two scores, more than two standard deviations below the mean for age-, gender-, and education-adjusted norms. One-hundred and one prospectively recruited PTCS patients were enrolled. The objective testing showed 30 patients had mild-single domain impairment, and 25 had mild-multi domain impairment. More patients without objective cognitive impairment had transverse venous sinus stenosis, but otherwise the groups did not differ. Two measures of headache severity, the Headache Impact Test and pain on the Numeric Rating Scale, were negatively associated with the composite cognitive score, as was ocular pain, vision-related disability, and mental health. Opening pressure and visual function were not associated with objective cognitive impairment. We found no association between subjective and objective cognitive impairment. Patients with PTCS may be cognitively impaired, and this correlates with measures of headache burden. Studies evaluating cognitive impairment before and after remission of the headache disorder would have to be performed to investigate this relationship further. Patients with self-perception of cognitive burden are no more likely to be cognitively impaired.

Chinese expert consensus on the interventional management of venous sinus stenosis

Venous sinus stenosis is a rare cerebrovascular disease. The management of venous sinus stenosis remains controversial. The evidence-based medical evidence was limited. There was not a specific consensus or guideline on the disease. This expert consensus provides an overview of cerebral venous sinus stenosis and comprehensive recommendations for the diagnosis, management, and interventional treatment by reviewing the relevant literature. The intended audience includes physicians and other healthcare providers who are responsible for patients with cerebral venous sinus stenosis. The present consensus aims to standardize and improve the clinical practice of venous sinus stenosis in China.

Improvement of exhausted cerebral autoregulation in patients with idiopathic intracranial hypertension benefit of venous sinus stenting

Objective. To evaluate the cerebral autoregulation (CA) in idiopathic intracranial hypertension (IIH) patients with transfer function analysis, and to explore its improvement after venous sinus stenting. Approach. In total, 15 consecutive IIH patients with venous sinus stenosis and 15 controls were recruited. All the patients underwent digital subtraction angiography and venous manometry. Venous sinus stenting was performed for IIH patients with a trans-stenosis pressure gradient ≥8 mmHg. CA was assessed before and after the operation with transfer function analysis, by using the spontaneous oscillations of the cerebral blood flow velocity in the bilateral middle cerebral artery and blood pressure. Main results. Compared with controls, the autoregulatory parameters, phase shift and rate of recovery, were both significantly lower in IIH patients [(57.94° ± 23.22° versus 34.59° ± 24.15°, p < 0.001; (39.87 ± 21.95) %/s versus (20.56 ± 46.66) %/s, p = 0.045, respectively). In total, six patients with bilateral transverse or sigmoid sinus stenosis received venous sinus stenting, in whom, the phase shift significantly improved after venous sinus stenting (39.62° ± 20.26° versus 22.79° ± 19.96°, p = 0.04). Significance. The study revealed that dynamic CA was impaired in IIH patients and was improved after venous sinus stenting. CA assessment has the potential to be used for investigating the hemodynamics in IIH patients.