Correlation between lumbar puncture opening pressure and venous sinus pressure gradient in idiopathic intracranial hypertension (IIH)

Amy T Fulton; Nathan T Tagg; Sidney M Gospe; Beiyu Liu; Shein-Chung Chow; Alexa N Bramall; Erik F Hauck

doi:10.1177/15910199251328547

Correlation between lumbar puncture opening pressure and venous sinus pressure gradient in idiopathic intracranial hypertension (IIH)

Interv Neuroradiol. 2025 Apr 24:15910199251328547. doi: 10.1177/15910199251328547. Online ahead of print.

Authors

Amy T Fulton^{1

2}, Nathan T Tagg², Sidney M Gospe³, Beiyu Liu⁴, Shein-Chung Chow⁴, Alexa N Bramall¹, Erik F Hauck¹

Affiliations

¹ Department of Neurosurgery, Duke University Hospital, Durham, NC, USA.
² Department of Neurology, Duke University Hospital, Durham, NC, USA.
³ Duke Eye Center, Duke University, Durham, NC, USA.
⁴ Duke CTSI Biostatistics, Epidemiology and Research Design (BERD) Methods Core, Durham, NC, USA.

Abstract

BackgroundVenous hypertension has become a recognized condition associated with idiopathic intracranial hypertension (IIH). Thresholds for dural venous sinus stenting (VSS) remain a topic of debate.MethodsIn 50 IIH patients, the lumbar puncture opening pressure (LPOP) and the pressure gradient across the dominant venous sinus were correlated. Clinical variables were compared; linear regression models were created. Venous stenting was performed in select patients with bilateral venous sinus stenosis, papilledema, LPOP >25 cmH2O, and a venous pressure gradient >10 mmHg.ResultsTwenty-nine patients were selected for venous sinus stenting (VSS); 21 patients did not meet the criteria for stenting despite some IIH symptoms. After stent implantation, patients experienced improvement in their symptoms.Across all 50 patients, there was a significant correlation between LPOP and the pressure gradient across the stenosis of the dominant venous sinus (r = 0.76, 95% confidence interval [0.53-1.00], P < .001).ConclusionsAn increased venous pressure gradient across the dominant sigmoid/transverse junction was strongly associated with an increased lumbar puncture opening pressure in IIH patients. A gradient increase of 1 mmHg correlated with an increase of LPOP by 0.85 cmH2O. Patients with higher baseline venous pressure gradients may therefore benefit the most from venous stenting.

Keywords: Dural venous sinus pressure; idiopathic intracranial hypertension; intracranial pressure (ICP); papilledema; sinus pressure gradient; venous sinus stent.