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. 2025 Sep 9;41(1):273.
doi: 10.1007/s00381-025-06938-7.

Intracranial venous pressures and endovascular outcomes in pediatric patients with cerebral venous sinus stenosis

Sage P Rahm  1 , Matthew Thomas Cleveland Jarrell  2 , Sasha Howell  1 , Anil Mahavadi  1 , Anastasia Smith  1 , James M Johnston  1 , Jesse G A Jones  1
Affiliations

Intracranial venous pressures and endovascular outcomes in pediatric patients with cerebral venous sinus stenosis

Sage P Rahm et al. Childs Nerv Syst. .

Abstract

Purpose: 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.

Methods: A retrospective chart review was performed on patients ≤ 18 years old with CVSS between October 2021 and August 2024.

Results: 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 mmH2O. 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.

Conclusion: 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.

Keywords: Balloon angioplasty; Cerebral venous sinus stenosis; Diagnostic cerebral venogram; Idiopathic intracranial hypertension; Venous sinus pressures; Venous sinus stenting.

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Conflict of interest statement

Declarations. Competing Interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Case illustration of patient #7 demonstrating cerebral venous sinus stenosis treated with cerebral venous sinus stenting. Anterior–posterior A and lateral B views of pre-stent venogram showing cerebral venous sinus stenosis. Stent placement C followed by post-stent radiograph D. Venous phase of post-stenting angiogram on anterior–posterior E and lateral F views. Pressure gradient pre-stenting: 17.7 mmHg; post-stenting: 5.9 mmHg
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