Enlarged Vertebral Venous Plexus Alleviated Intracranial Hypertension-Related Symptoms in Patients with Bilateral Transverse Sinus Stenosis

Abstract

<b><i>Background:</i></b> Enlarged vertebral venous plexus (EVVP) was often observed in patients with bilateral transverse sinus stenosis (BTSS). The purpose of this study was to investigate the physiological role of EVVP in BTSS patients. <b><i>Methods:</i></b> Forty-five BTSS patients and 92 normal controls were prospectively recruited from January 2014 to December 2019. The index of transverse sinus stenosis (ITSS) was used for the assessment of BTSS severity. Subjects underwent a standard lumbar puncture to measure the intracranial pressure (ICP). Papilledema and tinnitus were evaluated by using Frisén’s grade and questionnaires for Tinnitus Handicap Inventory (THI), respectively. The intensity and impact of headache were assessed by using 10-point Numeric Pain Rating Scale and six-item Headache Impact Test, respectively. <b><i>Results:</i></b> The BTSS group had more subjects with intracranial hypertension (IH) and less subjects with normal ICP than normal controls (<i>p</i> < 0.01; <i>p</i> < 0.01). BTSS patients had higher ICP than normal controls (<i>p</i> < 0.01). ICP was significantly lower in BTSS patients with EVVP than in those without EVVP (<i>p</i> < 0.01). No significant difference in ICP was found between normal controls with EVVP and those without EVVP (<i>p</i> = 0.99). A similar incidence of EVVP in BTSS patients and normal controls was found (<i>p</i> = 0.86). BTSS patients with IH exhibited a lower incidence of EVVP than those with normal ICP and overlapping ICP (<i>p</i> < 0.01; <i>p</i> < 0.01). The incidence of EVVP was not correlated with ITSS (<i>p</i> = 0.81). EVVP, rather than ITSS, correlated with ICP (<i>p</i> = 0.01). Furthermore, EVVP alleviated papilledema evaluated by Frisén’s grade and tinnitus evaluated by the THI score in BTSS patients (<i>p</i> = 004; <i>p</i> = 0.02). <b><i>Conclusions:</i></b> EVVP in normal controls is a congenital phenomenon that exerts no impact on ICP. However, the presence of EVVP reduces ICP and alleviates IH-related papilledema and tinnitus in BTSS patients.

Diastolic blood pressure predicts enlarged vertebral venous plexus and intracranial pressure in patients with bilateral transverse sinus stenosis

“…It has been reported that BTSS is correlated with IH (3). Results from our previous study also supported this finding (6). A triad of IH which manifested as headache, tinnitus, and papilledema are confirmed as the most common symptoms in patients with BTSS in this study.…”

“…Therefore, the presence of EVVP would guarantee sufficient cerebral venous reflux. Our previous report has demonstrated that EVVP compensates for the elevated ICP in patients with BTSS ( 6 ).…”

“…The inclusion criteria were as follows: symptomatic cases diagnosed as BTSS by magnetic resonance venography (MRV) and/or digital subtraction angiography (DSA). The representative images of BTSS and EVVP were as previously mentioned ( 6 ). The exclusion criteria were defined as follows: patients with (1) drug-related IH; (2) brain parenchymal lesions; (3) moderate to severe stenosis in intracranial, carotid, or vertebral arteries, (3) moderate to severe stenosis in internal jugular veins or intracranial sinuses other than transverse sinus.…”

“…The inclusion criteria were as follows: symptomatic cases diagnosed as BTSS by magnetic resonance venography (MRV) and/or digital subtraction angiography (DSA). The representative images of BTSS and EVVP were as previously mentioned (6). The exclusion criteria were defined as follows: patients with (1) drug-related IH;…”

“…Nonetheless, it is noteworthy that not every patient with BTSS experiences IH ( 5 ). Our previous study reported that the presence of enlarged vertebral venous plexus (EVVP) compensates for the elevated intracranial pressure (ICP) in patients with BTSS ( 6 ). However, no previous study has reported any influencing factor of EVVP.…”