Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
J Neurointerv Surg. 2018 Nov;10(11):1108-1113. doi: 10.1136/neurintsurg-2018-013858. Epub 2018 Mar 21.
Venous outflow obstruction is recognized as a contributing factor in a subset of patients with idiopathic intracranial hypertension (IIH). Little is known about venous sinus waveform morphology or how it changes after stenting.
Fifteen patients with IIH underwent waveform recording during catheter venography and manometry. Ten patients (Group A) with venous sinus stenosis and pressure gradient ≥7 mm Hg underwent waveform recording during awake venography and during stenting under general anesthesia. Five control IIH patients (Group B) without a gradient underwent awake recording only.
Group A patients underwent successful stenting with reduction of their gradient from 15.1±6.19 mm Hg to 1.2±0.60 mm Hg. This resulted in an amplitude reduction from 8.3 mm Hg to 2.8 mm Hg (P=0.02). Qualitative evaluation of the waveform yielded a number of novel findings. In Group A before stenting, the observed waveform progressed from an intracranial pressure (ICP)-dominated to central venous pressure (CVP)-dominated waveform. Stenting abolished the high amplitude waveform and smoothed the transition from the intracranial to central venous measurement points. Group B displayed primarily CVP-influenced waveforms distal and proximal to the transverse-sigmoid junction along with respiratory variability of the waveform, absent in 8/10 Group A patients. General anesthesia appeared to blunt the waveform in 5/10 Group A patients.
The cerebral venous waveform appears to be influenced by both the ICP and CVP waveforms. As measurement moves proximally, the waveform progressively changes to mirror the CVP waveform. Venous sinus stenosis results in a high amplitude waveform which improves with treatment of the stenosis.
静脉流出阻塞被认为是特发性颅内高压（IIH）患者亚群的一个致病因素。关于静脉窦波形形态或其在支架置入后的变化知之甚少。
15 例 IIH 患者在导管静脉造影和测压时进行了波形记录。10 例（A 组）静脉窦狭窄且压力梯度≥7mmHg 的患者在清醒静脉造影和全身麻醉下支架置入期间进行了波形记录。5 例无梯度的对照 IIH 患者（B 组）仅在清醒时进行记录。
A 组患者成功进行了支架置入，梯度从 15.1±6.19mmHg 降低至 1.2±0.60mmHg。这导致振幅从 8.3mmHg 降低至 2.8mmHg（P=0.02）。对波形的定性评估得出了一些新的发现。在支架置入前的 A 组中，观察到的波形从颅内压（ICP）主导转变为中心静脉压（CVP）主导。支架置入消除了高振幅波形，并使颅内和中心静脉测量点之间的过渡变得平滑。B 组在横窦乙状窦交界处远端和近端显示主要受 CVP 影响的波形，而 10 例 A 组患者中则没有呼吸变异。全身麻醉似乎使 10 例 A 组患者中的 5 例的波形变钝。
脑静脉波形似乎同时受到 ICP 和 CVP 波形的影响。随着测量位置向近端移动，波形逐渐改变以反映 CVP 波形。静脉窦狭窄导致高振幅波形，治疗狭窄后可改善。
