Rahm Sage P, Jarrell Matthew Thomas Cleveland, Howell Sasha, Mahavadi Anil, Smith Anastasia, Johnston James M, Jones Jesse G A
Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Children's of Alabama, 1600 7TH Avenue South, Lowder 400, Birmingham, AL, 35233, USA.
Childs Nerv Syst. 2025 Sep 9;41(1):273. doi: 10.1007/s00381-025-06938-7.
Diagnostic cerebral venograms are the gold standard for evaluating cerebral venous sinus stenosis (CVSS). Venous sinus stenting (VSS) and less commonly venous sinus angioplasty are emerging endovascular treatments in pediatric patients. This study examines the baseline intracranial venous pressures and postoperative endovascular outcomes in pediatric patients with CVSS.
A retrospective chart review was performed on patients ≤ 18 years old with CVSS between October 2021 and August 2024.
A total of fifteen patients with CVSS underwent 20 endovascular procedures. The average age was 13.0 years of age (IQR 6-15 years of age) and 53.3% female. Eight patients (53%) were diagnosed with IIH by the revised Friedman criteria. Papilledema was present in 73.3% of patients with an average lumbar puncture or ventriculostomy opening pressure of 409 mmHO. The average superior sagittal sinus (SSS) pressure was 24.3 mmHg (range 13-50 mmHg). The average trans-stenotic gradient was 8.5 mmHg (IQR 4.0-13.3; n = 14). Five patients underwent dural venous sinus stenting (mean pre-stent TSG of 17.0) with a significant reduction in the trans-stenotic gradient of 13.5 mmHg (p = 0.04; 79.4% relative reduction). One of these VSS patients developed stent adjacent stenosis (SAS) at follow-up requiring further venous sinus stenting. There was one peri-operative complication (5%) involving a retroperitoneal hematoma.
Initial dural venous sinus stenting significantly reduced the trans-stenotic gradient in all pediatric CVSS patients. Of the patients who underwent venous sinus angioplasty, 100% required further surgical intervention for management of their ICPs. There was one perioperative complication (5%) associated with CVSS endovascular interventions.
诊断性脑静脉造影是评估脑静脉窦狭窄（CVSS）的金标准。静脉窦支架置入术（VSS）以及较少见的静脉窦血管成形术是儿科患者中新兴的血管内治疗方法。本研究探讨了患有CVSS的儿科患者的基线颅内静脉压和术后血管内治疗结果。
对2021年10月至2024年8月期间年龄≤18岁的CVSS患者进行回顾性病历审查。
共有15例CVSS患者接受了20次血管内手术。平均年龄为13.0岁（四分位间距6 - 15岁），女性占53.3%。根据修订的弗里德曼标准，8例患者（53%）被诊断为IIH。73.3%的患者存在视乳头水肿，平均腰穿或脑室造瘘开放压为409 mmHO。上矢状窦（SSS）平均压力为24.3 mmHg（范围13 - 50 mmHg）。平均跨狭窄梯度为8.5 mmHg（四分位间距4.0 - 13.3；n = 14）。5例患者接受了硬脑膜静脉窦支架置入术（支架置入前平均跨狭窄梯度为17.0），跨狭窄梯度显著降低了13.5 mmHg（p = 0.04；相对降低79.4%）。其中1例VSS患者在随访时出现支架相邻狭窄（SAS），需要进一步进行静脉窦支架置入术。有1例围手术期并发症（5%），为腹膜后血肿。
初次硬脑膜静脉窦支架置入术显著降低了所有儿科CVSS患者的跨狭窄梯度。在接受静脉窦血管成形术的患者中，100%需要进一步的手术干预来处理其颅内压。有1例围手术期并发症（5%）与CVSS血管内干预相关。
