Treatment of tumor-induced cerebral venous sinus stenosis: Technical note and review of the literature

Abstract

Introduction: Tumors that invade or compress the venous sinuses have the potential to impair venous drainage. Rarely, this may be so severe as to induce intracranial hypertension. Other studies have previously described venous sinus stenting (VSS) for the treatment of these symptomatic lesions. In this report, we present our series of eight cases of VSS for symptomatic tumor-induced venous sinus stenosis and review the existing literature.

Cases: Eight patients with mostly intracranial tumors were found to have symptomatic venous sinus stenosis with the most common presenting symptom being elevated intracranial pressure. Six of the eight (75%) patients presented with papilledema on neuro-ophthalmological exam. The most affected locations were the transverse and sigmoid sinuses in four patients, followed by the superior sagittal sinus in three patients. All eight patients underwent VSS with no adverse events. In total, 6 out of 8 (75%) of patients had complete resolution of their symptoms, while the remaining patients experienced at least partial improvement.

Conclusion: Tumors that cause symptomatic venous sinus stenosis may be successfully managed with VSS to improve venous drainage. This may facilitate continued conservative management of meningiomas or allow for treatment with noninvasive means, such as stereotactic radiosurgery. Depending on the size of the target stenosis, balloon-mounted coronary stents may be a suitable option to treat these lesions.

Keywords: Cranial venous sinuses; elevated intracranial pressure; endovascular; meningioma; stent.

Figure 1.

(a) CT scan of case sample with midline dural-based meningioma compressing the posterior superior sagittal sinus (SSS). (b) MR venogram of sample case demonstrating focal stenosis of the posterior superior sagittal sinus indicated by the white arrow. (c) Post-stent venogram revealing no evidence of residual stenosis and patent flow through the implanted stent. (d) Sagittal magnetic resonance imaging with IV contrast of sample case showing SSS filling defect, as indicated by the white arrow. (e) MRI brain with IV contrast 1 year post-stenting displayed a signal dropout region of the stent with patent flow anterior and posterior to the stent. Dominant right transverse and sigmoid sinus are observed.