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Case Reports
. 2019 Jun 20;11(6):e4953.
doi: 10.7759/cureus.4953.

Venous Manometry as an Adjunct for Diagnosis and Multimodal Management of Intracranial Hypertension due to Meningioma Compressing Sigmoid Sinus

Cletus Cheyuo  1 , Charles L Rosen  2 , Ansaar Rai  3 , Christopher P Cifarelli  1 , Rabia Qaiser  4
Affiliations
Case Reports

Venous Manometry as an Adjunct for Diagnosis and Multimodal Management of Intracranial Hypertension due to Meningioma Compressing Sigmoid Sinus

Cletus Cheyuo et al. Cureus. .

Abstract

Intracranial venous hypertension is a rare presentation of meningiomas in the transverse-sigmoid sinus region. We describe a case of a young patient presenting with intracranial hypertension due to a meningioma causing compression of the dominant sigmoid sinus. We were able to document the cerebral venous pressure gradient across the lesion confirming our hypothesis that compression of the sigmoid sinus from the meningioma was the cause of intracranial hypertension. The patient is a 17-year-old male who presented with intracranial hypertension due to meningioma at the right dominant sigmoid sinus, which was treated by a Simpson grade IV surgical resection followed by stereotactic radiosurgery. Following treatment, his papilledema resolved and he remains symptom-free at 18 months. In conclusion, venous manometry is a useful adjunct to diagnose intracranial hypertension in non-idiopathic causes of intracranial hypertension. A multimodal management approach of intracranial hypertension due to outflow obstruction from the dominant sinus led to an excellent recovery on follow up.

Keywords: intracranial hypertension; sigmoid sinus meningioma; stereotactic radiosurgey; venous manometry.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Preoperative magnetic resonance imaging (MRI) brain with gadolinium contrast
(A) Axial and (B) coronal views showing an enhancing 1.5 cm extra-axial mass (solid yellow arrows) causing stenosis of the right sigmoid sinus.
Figure 2
Figure 2. Magnetic resonance imaging (MRI) of the orbits with gadolinium contrast demonstrating papilledema
(A) Axial T2W showing flattening of the posterior sclera (dashed yellow arrow), distension of the peri-optic subarachnoid space (solid blue arrow) and vertical tortuosity of the orbital optic nerve (solid yellow arrow) and (B) Axial T1W with contrast showing enhancement of the prelaminar optic nerve (solid red arrow) and intraocular protrusion of the prelaminar optic nerve (dashed red arrow).
Figure 3
Figure 3. Diagnostic cerebral angiogram showing a filling defect within the right sigmoid sinus (curved yellow arrow) due to the mass lesion, and a hypoplastic left transverse sinus (straight yellow arrow).
Figure 4
Figure 4. Post-operative magnetic resonance imaging (MRI) brain with gadolinium contrast
(A) Axial and (B) coronal views showing partial resection of tumor at the right sigmoid sinus region (solid yellow arrows)
See this image and copyright information in PMC

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