Cranial Venous Outflow Obstruction and Pseudotumor Cerebri Syndrome

Owler, Brian; Parker, Glendon J.; Hálmagyi, G. Michael; Johnston, Ian; Besser, Michael; Pickard, John D.; Higgins, J. Nicholas P.

doi:10.1007/3-211-27208-9_4

Cited by 73 publications

(38 citation statements)

References 165 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 All our 52 patients with IIH had high sagittal sinus pressures and stenosis of either their dominant transverse sinus (21 patients) or both transverse sinuses (31 patients). Stent placement to open just 1 transverse sinus immediately normalized venous pressures, abolished papilledema in all patients, and resolved IIH symptoms in 49/52 patients.…”

Section: Discussionmentioning

confidence: 90%

Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions

Ahmed

Wilkinson²,

Parker³

et al. 2011

AJNR Am J Neuroradiol

350

320

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE:Transverse sinus stenosis is common in patients with IIH. While the role of transverse sinus stenosis in IIH pathogenesis remains controversial, modeling studies suggest that stent placement within a transverse sinus stenosis with a significant pressure gradient should decrease cerebral venous pressure, improve CSF resorption in the venous system, and thereby reduce intracranial (CSF) pressure, improving the symptoms of IIH and reducing papilledema. We aimed to determine if IIH could be reliably treated by stent placement in transverse sinus stenosis.

show abstract

Section: Discussionmentioning

confidence: 90%

Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions

Ahmed

Wilkinson²,

Parker³

et al. 2011

AJNR Am J Neuroradiol

350

320

View full text Add to dashboard Cite

show abstract

“…Bilateral transverse sinus stenosis is found in 90% of sufferers (Bono et al, 2005;Higgins et al, 2005;Karahalios et al,1996;Pickard et al, 2008), and has been successfully treated with endoluminal stenting (Donnet et al, 2008b;Higgins et al, 2002;Higgins et al, 2003;Owler et al, 2005). Other studies have demonstrated internal jugular stenosis in 80% (Alperin et al, 2005).…”

Section: Idiopathic Intracranial Hypertension (Iih) and Transverse Simentioning

confidence: 89%

The Headache of High Altitude and Microgravity—Similarities with Clinical Syndromes of Cerebral Venous Hypertension

Imray

Hargens

2011

High Altitude Medicine & Biology

View full text Add to dashboard Cite

Syndromes thought to have cerebral venous hypertension as their core, such as idiopathic intracranial hypertension and jugular foramen outlet obstruction, classically result in headaches. Do they provide an insight into the cause of the headache that commonly occurs at altitude? The classic theory of the pathogenesis of high altitude headache has been that it results from increased intracranial pressure (ICP) secondary to hypoxemia in people who have less compliant intracranial volumes (Roach and Hackett, 2001). However, there does not appear to be a correlation between the headache of acute mountain sickness (AMS) and the presence of cerebral edema (Bailey et al, 2006; Wilson et al, 2009). Research has concentrated on arterial perfusion to the brain in hypoxia, but there has been little study of venous drainage. Hypoxia results in markedly increased cerebral blood flow; however, if it has been considered at all, venous outflow has to date been assumed to be of little consequence. Retinal venous distension and the increased venous blood demonstrated by near infra-red spectroscopy and more recently by MRI imply that, in hypoxia, a relative venous insufficiency may exist. Similarly, there is increasing evidence that manifestations of the fluid shift during microgravity is of similar nature to idiopathic intracranial hypertension, which is thought to be primarily a venous insufficiency condition. The unique anthropomorphic adaptations of large brained biped humans with cerebral venous systems that have to cope with large changes in hydrostatic pressure may predispose us to conditions of inflow/outflow mismatch. In addition, slight increases in central venous pressures (e.g., from hypoxia-induced pulmonary vasoconstriction) may further compromise venous outflow at altitude. A better understanding of cerebral venous physiology may enlighten us with regards the pathogenesis of headaches currently considered idiopathic. It may also enable us to trigger headaches for study and hence enable us to develop new treatment strategies.

show abstract

“…Depending on the compliance of venous sinuses, the CSF pressure elevation may compress them and exacerbate outflow obstruction, further increasing venous pressure that could extend to the feeding veins [42]. King et al [43] showed a drop in transverse sinus pressures after direct CSF removal by cervical puncture, and there have also been reports of lateral sinus stenotic lesions resolving after CSF diversion procedures [44], suggesting that venous hypertension is due to transverse sinus compression by raised ICP and not due to a primary obstructive process.…”

Section: Venous Sinus Stenosismentioning

confidence: 99%