Intracranial Venous Pressures and Endovascular Procedure Complications in Pediatric Patients with Cerebral Venous Sinus Stenosis

Introduction: Cerebral venous sinus stenosis (CVSS) is a rare condition in pediatric patients and is frequently associated with idiopathic intracranial hypertension (IIH). Diagnostic cerebral venograms are the gold standard for evaluating the degree of CVSS along with intracranial venous pressures. This study examines the baseline intracranial venous pressures and postoperative endovascular complication rates in pediatric patients with CVSS.

Methods: Following IRB approval, a retrospective chart review was performed on patients < 18 years old with CVSS between October 2021 and August 2024. Variables collected include basic demographic background information, presence of papilledema, lumbar puncture or ventriculostomy opening pressure, intracranial venous sinus pressures, interventions performed, and endovascular procedure complications (within 30 days).

Results: A total of nine patients with CVSS who underwent diagnostic cerebral venograms were included in this study. The average age was 12.6 years of age (range 6-17 years of age) and two-thirds female. Eight patients were diagnosed with IIH. Papilledema was present in 78% of patients with an average lumbar puncture or ventriculostomy opening pressure of 38.7 cmH20 (range 18-60 cmH20). All patients had either unilateral or bilateral transverse sinus stenosis with an average superior sagittal sinus pressure of 24.7 mmHg (range 13-43 mmHg). The average trans-stenotic gradient was 10.8 mmHg (SD 9.1 mmHg). Four patients underwent dural venous sinus stenting with an average reduction in the trans-stenotic gradient of 10.8 mmHg (SD 10.5 mmHg; range 3-26mmHg). There were no immediate postoperative complications.

Conclusion : In this study, there were no immediate complications with any of the endovascular interventions. Dural venous sinus stenting effectively reduced the trans-stenotic gradient in these pediatric CVSS patients. Further studies are needed to understand the degree to which CVSS affects intracranial venous pressures, but this study helps elucidate a baseline degree of pressure elevation in this patient population.