Transient resolution of venous sinus stenosis after high-volume lumbar puncture in a patient with idiopathic intracranial hypertension

J Neurosurg. 2018 Jul;129(1):153-156. doi: 10.3171/2017.3.JNS163181. Epub 2017 Aug 25.


Stenosis of the transverse sinus (TS) and sigmoid sinus (SS), with a trans-stenosis pressure gradient, has been implicated in the pathophysiology of idiopathic intracranial hypertension (IIH). MRI has shown improvement in TS and SS stenosis after high-volume lumbar puncture (HVLP) in a subset of patients with IIH. The authors present the first report of an IIH patient with immediate post-HVLP TS and SS trans-stenosis pressure gradient reduction and an attendant increase in TS and SS cross-sectional area confirmed using intravascular ultrasonography (IVUS). Recurrence of the patient's TS-SS stenosis coincided with elevated HVLP opening pressure, and venous sinus stent placement resulted in clinical improvement. This report suggests that TS and SS stenosis may be a downstream effect of elevated intracranial pressure in IIH, rather than its principal etiological mechanism. However, the authors hypothesize that endovascular stenting may obliterate a positive feedback loop involving trans-stenosis pressure gradients, and still benefit appropriately selected patients.

Keywords: BMI = body mass index; HVLP = high-volume lumbar puncture; ICP = intracranial pressure; IIH = idiopathic intracranial hypertension; IVUS = intravascular ultrasonography; MVP = mean venous pressure; SS = sigmoid sinus; TS = transverse sinus; diagnostic technique; idiopathic intracranial hypertension; intracranial venous sinus; intravascular ultrasonography; stenosis; venous manometry.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Constriction, Pathologic
  • Cranial Sinuses*
  • Female
  • Humans
  • Intracranial Hypertension / complications
  • Intracranial Hypertension / surgery*
  • Remission Induction
  • Spinal Puncture* / methods
  • Time Factors
  • Vascular Diseases / complications
  • Vascular Diseases / surgery*