Journal of Neurosciences in Rural Practice
Year : 2019  |  Volume : 10  |  Issue : 2  |  Page : 334-338

Concurrent venous stenting of the transverse and occipito-marginal sinuses: An analogy with parallel hemodynamic circuits

1 Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
2 Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
3 Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
4 Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
5 Department of Neurosurgery, Pennsylvania State University, Hershey, Pennsylvania, USA

Correspondence Address:
Thomas J Buell
Department of Neurosurgery, University of Virginia Health System, Box: 800212, Charlottesville, Virginia 22908
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnrp.jnrp_259_18

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Nonthrombotic intracranial venous occlusive disease (NIVOD) has been implicated in the pathophysiology of idiopathic intracranial hypertension (IIH) and various non-IIH headache syndromes. Endovascular stenting of stenotic, dominant transverse sinuses (TSs) may reduce trans-stenosis pressure gradients, decrease intracranial pressure, and alleviate symptoms in a subset of NIVOD patients. We present a case in which concurrent stenting of the occipito-marginal sinus obliterated the residual trans-stenosis pressure gradient across an initially stented dominant TS. We hypothesize that this observation may be explained using an electric-hydraulic analogy, and that this patient's dominant TS and occipito-marginal sinus may be modeled as a parallel hemodynamic circuit. Neurointerventionalists should be aware of parallel hemodynamic drainage patterns and consider manometry and possibly additional stenting of stenotic, parallel venous outflow pathways if TS stenting alone fails to obliterate the trans-stenosis pressure gradient.

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