Occipital venous sinus stenting for idiopathic intracranial hypertension and pulsatile tinnitus: A case series

Abstract

Venous sinus stenting for dural venous sinus outflow obstruction due to an intrinsic filling obstruction or extrinsic stenosis is an increasingly popular treatment strategy for idiopathic intracranial hypertension (IIH) and isolated pulsatile tinnitus (PT). The most common site of stenosis is the lateral venous sinus at the transverse-sigmoid junction. Approximately 10% of the population has a persistent occipital venous sinus (OVS), a variant that may be the dominant venous drainage pathway in the setting of a hypoplastic or aplastic transverse sinus. OVS stenosis has been rarely associated with IIH and isolated PT with only a handful published cases. We herein report a retrospective series of OVS stenting in five patients, four of whom presented with non-IIH PT and one with IIH.

Keywords: Occipital sinus; dural venous sinus stenting; idiopathic intracranial hypertension; pulsatile tinnitus.

Figure 1.

Catheter cerebral venogram superior sagittal sinus injection (a, b) frontal and lateral views before stenting showing the right-sided dominant occipital sinus and hypoplastic transverse sinus; (c, d) unsubtracted frontal and lateral views showing stent placement; and (e, f) superior sagittal sinus injection frontal and lateral views after stenting showing a larger occipital sinus caliber which drains the entirety of venous outflow into the jugular bulb, without contribution from the transverse sinus as seen previously.

Figure 2.

Catheter cerebral venogram superior sagittal sinus injection (a, b) frontal and lateral views before stenting showing the right-sided dominant occipital sinus, post-stenotic venous aneurysm (white arrow), and hypoplastic transverse sinus; (c, d) unsubtracted frontal and lateral views showing transverse-sigmoid junction stent placement; (e, f) unsubtracted frontal and lateral views occipital sinus stent placement; (g, h) right common carotid artery injection frontal and lateral views after stenting showing larger occipital and lateral sinus calibers.

Figure 3.

(a, c, e) catheter cerebral venogram superior sagittal sinus injection frontal views showing pre-stent dominant stenotic occipital sinuses; post-stent (b and d) cerebral angiogram vertebral artery injections and (f and g) venogram superior sagittal sinus injections showing increased sinus calibers.

Figure 4.

Magnetic resonance venography showing patent stent in the right occipital sinus (arrow).

Figure 5.

Magnetic resonance venography showing patent stent in the right occipital sinus (arrow).