Resolution of venous pressure gradient in a patient with idiopathic intracranial hypertension after ventriculoperitoneal shunt placement: A proof of secondary cerebral sinovenous stenosis

Buell, Thomas J.; Ding, Dale; Raper, Daniel; Chen, Ching-Jen; Aljuboori, Zaid; Taylor, Davis G.; Wang, Tony; Ironside, Natasha; Starke, Robert M.; Liu, Kenneth

doi:10.25259/sni_700_2020

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…CSF divergence can be the logical step to reduce the disturbed balance between secretion and drainage of CSF, with an increase in total intracranial fluid content, to compensate for other possible links such as intracerebral venous and glymphatic system compression secondary to intracranial hypertension, but also large venous sinus compression with extrinsic stenosis. This secondary venous sinus stenosis can lead to a further increase in ICP, which creates a vicious cycle where the increase in ICP produces a worsened secondary sinus stenosis and higher venous pressure [ 51 , 54 ]. There is evidence that drainage of CSF with a reduction of ICP can also reverse the transverse sinus collapse in patients with idiopathic intracranial hypertension [ 54 , 55 ].…”

Section: Management Of Iihmentioning

confidence: 99%

“…This secondary venous sinus stenosis can lead to a further increase in ICP, which creates a vicious cycle where the increase in ICP produces a worsened secondary sinus stenosis and higher venous pressure [ 51 , 54 ]. There is evidence that drainage of CSF with a reduction of ICP can also reverse the transverse sinus collapse in patients with idiopathic intracranial hypertension [ 54 , 55 ].…”

Section: Management Of Iihmentioning

confidence: 99%

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

Tuță

2022

Life

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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.

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Section: Management Of Iihmentioning

confidence: 99%

Section: Management Of Iihmentioning

confidence: 99%

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

Tuță

2022

Life

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“…Brain swelling from acute brain injury may negatively impact on venous drainage through compression of the large venous sinuses, particularly the sagittal and transverse sinuses. 48 , 52–54 The ICP waveform and the brain PPG changes seen with raised ICP are likely to represent prolonged systolic brain volume expansion due to a mismatch between arterial blood flow in and limited venous flows out. The ICP waveform peak is therefore delayed with a dominant P2.…”

Section: Discussionmentioning

confidence: 99%

“… 55 Studies have demonstrated that augmenting venous drainage resolves these ICP waveform changes and reduces the ICP. 48 , 52–54 …”

Section: Discussionmentioning

confidence: 99%

Assessment of a Non-Invasive Brain Pulse Monitor to Measure Intra-Cranial Pressure Following Acute Brain Injury

Dixon

Teo

Grace³

et al. 2023

MDER

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Background Intracranial pressure (ICP) monitoring requires placing a hole in the skull through which an invasive pressure monitor is inserted into the brain. This approach has risks for the patient and is expensive. We have developed a non-invasive brain pulse monitor that uses red light to detect a photoplethysmographic (PPG) signal arising from the blood vessels on the brain’s cortical surface. The brain PPG and the invasive ICP waveform share morphological features which may allow measurement of the intracranial pressure. Methods We enrolled critically ill patients with an acute brain injury with invasive ICP monitoring to assess the new monitor. A total of 24 simultaneous invasive ICP and brain pulse monitor PPG measurements were undertaken in 12 patients over a range of ICP levels. Results The waveform morphologies were similar for the invasive ICP and brain pulse monitor PPG approach. Both methods demonstrated a progressive increase in the amplitude of P2 relative to P1 with increasing ICP levels. An automated algorithm was developed to assess the PPG morphological features in relation to the ICP level. A correlation was demonstrated between the brain pulse waveform morphology and ICP levels, R 2 =0.66, P < 0.001. Conclusion The brain pulse monitor’s PPG waveform demonstrated morphological features were similar to the invasive ICP waveform over a range of ICP levels, these features may provide a method to measure ICP levels. Trial Registration ACTRN12620000828921.

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“…6 The mechanistic underpinnings of IIH remain poorly understood. Fundamentally, VSS has been both shown to persist in patients with resolved intracranial hypertension through pharmacologically driven decreased CSF production and resolve in others with CSF removal [16][17][18] This highlights our limited understanding of the progression and causes of IIH, specifically as it relates to VSS. Recent evidence suggests that in some cases VSS plays a significant role as either a primary or a secondary mechanism of impaired outflow.…”

Section: Discussionmentioning

confidence: 99%

Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension

et al. 2022

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Background 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. Methods 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. Results 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. Conclusions 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.

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Resolution of venous pressure gradient in a patient with idiopathic intracranial hypertension after ventriculoperitoneal shunt placement: A proof of secondary cerebral sinovenous stenosis

Cited by 7 publications

References 15 publications

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

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

Assessment of a Non-Invasive Brain Pulse Monitor to Measure Intra-Cranial Pressure Following Acute Brain Injury

Primary balloon angioplasty of venous Sinus stenosis in idiopathic intracranial hypertension

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