Imaging Characteristics of Sigmoid Sinus Wall Anomalies, Idiopathic Intracranial Hypertension, and Spontaneous CSF Leaks

Abstract

Objective:To assess the frequency of radiographic features of elevated intracranial pressure (ICP) in patients with sigmoid sinus wall anomalies (SSWA) and compare to those in idiopathic intracranial hypertension (IIH) and spontaneous CSF (sCSF) leaks.Study Design:Retrospective review.Setting:Tertiary care center.Patients:110 patients - 62 SSWAs, 19 IIH, 29 sCSF leaks.Main Outcome Measures:Demographics, comorbidities and radiographic features by diagnosis.Results:Imaging findings indicative of elevated ICP were similar across all three groups, as were body mass index, hyperlipidemia and diabetes. On univariate analysis, sCSF leak patients were significantly older than SSWA (60 vs. 41 years, p < 0.001) and IIH (60 vs. 40 years, p < 0.001) patients. They had a greater prevalence of arachnoid granulations than SSWA (75.8% vs. 37.1%, p < 0.01) and tegmen dehiscence than both SSWA and IIH (93.1% vs. 75.8% vs. 57.8%, p = 0.01), though a lower prevalence of empty sella than SSWA (44.8% vs. 72.5%, p < 0.001). SSWAs were present in roughly 44.3% of IIH and sCSF leak patients, and IIH in roughly 15.8% of SSWA and sCSF leak patients. Age (OR = 1.1, p = 0.001), hypertension (OR = 8.3, p = 0.01) and empty sella (OR = 0.1, p = 0.01) were predictive of sCSF leaks compared to SSWAs on multivariate analysis.Conclusions:Many radiographic and clinical features of elevated ICP are found at similar rates among patients with SSWA, IIH and sCSF leaks, suggesting a common underlying process. SSWAs seem to present earlier along this spectrum of phenotypes, while sCSF leaks present later. Differences in age, metabolic syndrome and ICP may influence a patient's clinical presentation.

Evidence of air‐conduction transmission pathway and strategized transtemporal operative techniques for venous pulsatile tinnitus: Combining water occlusion test and operative sensing applications

“…This may be due to the regulation of flow dynamics via the external jugular and vertebral pathways. Although it is highly possible that some degree of flow anomaly/increase in intracranial pressure promotes osteolytic effects, 19,20 increased cerebrospinal opening pressure is not a definitive finding in patients with PT associated with SSWAs. 28 Except for neuro-ophthalmologic signs or symptoms of IIH, neuroimaging findings are not required for the diagnosis of definite IIH.…”

“…7 Researchers have also suggested that spontaneous cerebrospinal fluid leakage can occur in the late stage of SSWA development if increases in intracranial pressure remain unresolved. 19 Furthermore, a recent study provided striking evidence suggesting that addressing flow pathologies can reverse the process of SSWA formation. 20 SSWAs may therefore represent anatomical abnormalities that develop due to pathologic accumulation of flow perturbations.…”

Resurfacing Dehiscence(s) Without Reducing Diverticulum Effectively Silences Pulsatile Tinnitus: Novel Surgical Techniques for Diverticulum and Intraoperative Microphone Monitoring

“…In addition, some patients may have IIH without papilledema, exhibiting a moderate increase in intracranial pressure. Further investigation is required to elucidate the true cause of skull base erosion, such as SSWAs and spontaneous cerebrospinal fluid leak, among others (40). Lastly, qualitative methods for analyzing the thickness of the vascular wall and dura over SSWAs are limited.…”

Case report: Novel transtemporal transverse sinus decompression surgery to alleviate transverse sinus stenosis in a pulsatile tinnitus patient with restricted bilateral venous outflow

“…SSWAs include sigmoid sinus diverticulum (SSD) and wall dehiscence, both of which are believed to result from distal TS stenosis and elevated intracranial pressure commonly observed in individuals with idiopathic intracranial hypertension (IIH) (4). However, while TS stenosis is a common finding in the normal population, SSWAs are comparatively rare, making them more likely to be associated with PT generation (5).…”