2007
DOI: 10.1093/imammb/dql025
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Idiopathic intracranial hypertension and transverse sinus stenosis: a modelling study

Abstract: Idiopathic intracranial hypertension (IIH) is a syndrome of unknown etiology characterized by elevated intracranial pressure (ICP). Although a stenosis of the transverse sinus has been observed in many IIH patients, the role this feature plays in IIH is in dispute. In this paper, a lumped-parameter model is developed for the purpose of analytically investigating the elevated pressures associated with IIH and a collapsible transverse sinus. This analysis yields practical predictions regarding the degree of elev… Show more

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Cited by 35 publications
(46 citation statements)
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“…It has been proposed on the basis of mathematic models 25 that intracranial hypertension compresses the collapsible transverse sinus causing venous outflow obstruction, which results in further venous hypertension, which then decreases CSF absorption and causes further increases in intracranial pressure, which then feeds back causing further external compression of the transverse sinus and further stenosis. 25 In our 52 patients, regardless of whether the stenosis was extrinsic compression, suggesting a secondary cause of stenosis, or intrinsic, suggesting a primary origin, the absence of even 1 normal low-resistance transverse sinus resulted in venous hypertension and the clinical picture of IIH. Creation of just 1 functioning low-resistance transverse sinus by stent placement, resulted in the resolution of venous hypertension and of the IIH.…”
Section: Discussionmentioning
confidence: 99%
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“…It has been proposed on the basis of mathematic models 25 that intracranial hypertension compresses the collapsible transverse sinus causing venous outflow obstruction, which results in further venous hypertension, which then decreases CSF absorption and causes further increases in intracranial pressure, which then feeds back causing further external compression of the transverse sinus and further stenosis. 25 In our 52 patients, regardless of whether the stenosis was extrinsic compression, suggesting a secondary cause of stenosis, or intrinsic, suggesting a primary origin, the absence of even 1 normal low-resistance transverse sinus resulted in venous hypertension and the clinical picture of IIH. Creation of just 1 functioning low-resistance transverse sinus by stent placement, resulted in the resolution of venous hypertension and of the IIH.…”
Section: Discussionmentioning
confidence: 99%
“…49 A mathematic model of intracranial pressure dynamics provides a quantitative rationale for transverse sinus stent placement in IIH. 25 This model consists of 5 intracranial compartments, with associated pressures and volumes and fluid flows between them (see On-Line Appendix for an overview). Unlike previous models of intracranial pressure, this model introduces a Starling-like resistance between the proximal and distal venous sinuses.…”
Section: Discussionmentioning
confidence: 99%
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“…21 Mathematical models support the hypothesis that the transverse sinus is a compliant structure to the point of being vulnerable to extrinsic compression, which may obstruct the venous drainage, resulting in venous and intracranial hypertension. 24 On the other hand, results published in recent years, which show clinical improvement in some patients after the reconstruction of the transverse sinus with endovascular stents, reinforce the hypothesis that the stenosis established in the sinus independently causes the venous flow blockage. 13,22 These two alternatives may give rise to similar symptomatology, alone or concomitantly, explaining the variability in outcomes seen on the clinical assessment of patients.…”
Section: Discussionmentioning
confidence: 81%
“…Recently, we reported [4,5] the results of modeling studies that suggest the observed sinus stenosis and persistent hypertension of IIH may be a physiological manifestation of a stable steady-state of elevated pressures predicted by the studies to exist when the transverse sinus is sufficiently collapsible. These results provide explanations for the following phenomenon associated with IIH: 1) the observed sinus stenosis, 2) intermittent occurrence of symptoms, 3) large pressure gradients observed across the transverse sinus, 4) the long-term relief that has been observed following lumbar puncture, and 5) the possible persistence of sinus stenosis after the hypertension has been resolved via pharmaceutical treatment and weight loss.…”
Section: Introductionmentioning
confidence: 92%