Iyer Ankitha M, Midtlien Jackson P, Kittel Carol, Klever Lucas A, Wiater Angelina, Chang Emily, Margraf Connor, Fargen Kyle M
Neurological Surgery and Radiology, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.
Neurological Surgery and Radiology, Atrium Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
J Neurointerv Surg. 2025 Jan 27. doi: 10.1136/jnis-2024-022250.
The pathophysiology of idiopathic intracranial hypertension (IIH) and other cerebral venous outflow disorders (CVD) has largely been unexplored. While a correlation between venous sinus pressure and opening pressure (OP) has been previously noted, there are limited data on this relationship in patients with prior venous sinus stenting (VSS).
A single center retrospective chart review was conducted on CVD patients who underwent diagnostic cerebral venography with manometry followed immediately by lateral decubitus lumbar puncture, from 2016 to 2024.
206 patients underwent 216 total procedures and were included. Among all patients, there was a moderate nearly one-to-one correlation between OP and torcular or superior sagittal sinus (SSS) pressures. Thirty-two patients underwent testing after having undergone VSS. Patients with previous VSS showed a significantly altered relationship between venous pressures and OP, whereby as venous sinus pressures increased, OP increased more gradually in previously stented patients compared with non-stented patients. For example, when OP was fixed at 21 mm Hg and body mass index at 30 kg/m, predicted mean SSS pressure was 19.47 mm Hg in non-stented patients versus 16.91 mm Hg in stented patients.
This study confirmed a strong relationship between OP and venous sinus pressure in CVD patients. However, patients with previous VSS demonstrated an altered relationship with higher CSF pressures relative to venous pressures compared with naïve patients. This finding may have important clinical implications in the management of IIH patients.
特发性颅内高压（IIH）和其他脑静脉流出道疾病（CVD）的病理生理学在很大程度上尚未得到探索。虽然此前已注意到静脉窦压力与开放压（OP）之间的相关性，但关于既往接受静脉窦支架置入术（VSS）的患者中这种关系的数据有限。
对2016年至2024年期间接受诊断性脑静脉造影并测压，随后立即进行侧卧位腰椎穿刺的CVD患者进行单中心回顾性病历审查。
206例患者共接受了216次手术并被纳入研究。在所有患者中，OP与窦汇或上矢状窦（SSS）压力之间存在中等程度的近乎一对一的相关性。32例患者在接受VSS后进行了测试。既往接受VSS的患者静脉压力与OP之间的关系发生了显著改变，即随着静脉窦压力升高，与未置入支架的患者相比，既往置入支架的患者OP升高更为缓慢。例如，当OP固定在21 mmHg且体重指数为30 kg/m²时，未置入支架的患者预测平均SSS压力为19.47 mmHg，而置入支架的患者为16.91 mmHg。
本研究证实了CVD患者中OP与静脉窦压力之间存在密切关系。然而，与未接受过治疗的患者相比，既往接受VSS的患者表现出与较高脑脊液压力相对于静脉压力的关系改变。这一发现可能对IIH患者的管理具有重要的临床意义。
