TY - JOUR
T1 - Incidence and predictors of dural venous sinus pressure gradient in idiopathic intracranial hypertension and non-idiopathic intracranial hypertension headache patients
T2 - Results from 164 cerebral venograms
AU - Levitt, Michael R.
AU - Hlubek, Randall J.
AU - Moon, Karam
AU - Kalani, M. Yashar S.
AU - Nakaji, Peter
AU - Smith, Kris A.
AU - Little, Andrew S.
AU - Knievel, Kerry
AU - Chan, Jane W.
AU - McDougall, Cameron G.
AU - Albuquerque, Felipe C.
N1 - Publisher Copyright:
© AANS, 2017.
PY - 2017/2
Y1 - 2017/2
N2 - OBJectiVe Cerebral venous pressure gradient (CVPG) from dural venous sinus stenosis is implicated in headache syndromes such as idiopathic intracranial hypertension (IIH). The incidence of CVPG in headache patients has not been reported. MethODS The authors reviewed all cerebral venograms with manometry performed for headache between January 2008 and May 2015. Patient demographics, headache etiology, intracranial pressure (ICP) measurements, and radio-graphic and manometric results were recorded. CVPG was defined as a difference ≥ 8 mm Hg by venographic manometry. reSUltS One hundred sixty-four venograms were performed in 155 patients. There were no procedural complications. Ninety-six procedures (58.5%) were for patients with IIH. The overall incidence of CVPG was 25.6% (42 of 164 procedures): 35.4% (34 of 96 procedures) in IIH patients and 11.8% (8 of 68 procedures) in non-IIH patients. Sixty procedures (36.6%) were performed in patients with preexisting shunts. Seventy-seven patients (49.7%) had procedures preceded by an ICP measurement within 4 weeks of venography, and in 66 (85.7%) of these patients, the ICP had been found to be elevated. CVPG was seen in 8.3% (n = 5) of the procedures in the 60 patients with a preexisting shunt and in 0% (n = 0) of the 11 procedures in the 77 patients with normal ICP (p < 0.001 for both). Noninvasive imaging (MR venography, CT venography) was assessed prior to venography in 112 (68.3%) of 164 cases, and dural venous sinus abnormalities were demonstrated in 73 (65.2%) of these cases; there was a trend toward CVPG (p = 0.07). Multivariate analysis demonstrated an increased likelihood of CVPG in patients with IIH (OR 4.97, 95% CI 1.71–14.47) and a decreased likelihood in patients with a preexisting shunt (OR 0.09, 95% CI 0.02–0.44). cOnclUSiOnS CVPG is uncommon in IIH patients, rare in those with preexisting shunts, and absent in those with normal ICP.
AB - OBJectiVe Cerebral venous pressure gradient (CVPG) from dural venous sinus stenosis is implicated in headache syndromes such as idiopathic intracranial hypertension (IIH). The incidence of CVPG in headache patients has not been reported. MethODS The authors reviewed all cerebral venograms with manometry performed for headache between January 2008 and May 2015. Patient demographics, headache etiology, intracranial pressure (ICP) measurements, and radio-graphic and manometric results were recorded. CVPG was defined as a difference ≥ 8 mm Hg by venographic manometry. reSUltS One hundred sixty-four venograms were performed in 155 patients. There were no procedural complications. Ninety-six procedures (58.5%) were for patients with IIH. The overall incidence of CVPG was 25.6% (42 of 164 procedures): 35.4% (34 of 96 procedures) in IIH patients and 11.8% (8 of 68 procedures) in non-IIH patients. Sixty procedures (36.6%) were performed in patients with preexisting shunts. Seventy-seven patients (49.7%) had procedures preceded by an ICP measurement within 4 weeks of venography, and in 66 (85.7%) of these patients, the ICP had been found to be elevated. CVPG was seen in 8.3% (n = 5) of the procedures in the 60 patients with a preexisting shunt and in 0% (n = 0) of the 11 procedures in the 77 patients with normal ICP (p < 0.001 for both). Noninvasive imaging (MR venography, CT venography) was assessed prior to venography in 112 (68.3%) of 164 cases, and dural venous sinus abnormalities were demonstrated in 73 (65.2%) of these cases; there was a trend toward CVPG (p = 0.07). Multivariate analysis demonstrated an increased likelihood of CVPG in patients with IIH (OR 4.97, 95% CI 1.71–14.47) and a decreased likelihood in patients with a preexisting shunt (OR 0.09, 95% CI 0.02–0.44). cOnclUSiOnS CVPG is uncommon in IIH patients, rare in those with preexisting shunts, and absent in those with normal ICP.
KW - Benign intracranial hypertension
KW - Headache
KW - Idiopathic intracranial hypertension
KW - Interventional neurosurgery
KW - Manometry
KW - Pseudotumor cerebri
KW - Venography
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U2 - 10.3171/2015.12.JNS152033
DO - 10.3171/2015.12.JNS152033
M3 - Article
C2 - 26967777
AN - SCOPUS:85028688313
SN - 0022-3085
VL - 126
SP - 347
EP - 353
JO - Journal of neurosurgery
JF - Journal of neurosurgery
IS - 2
ER -