Venous Sinus Stenosis Diagnosis

Venous sinus stenosis (VSS) is a narrowing of the major dural venous sinuses, typically the transverse and/or sigmoid sinuses, often associated with idiopathic intracranial hypertension (IIH). Diagnosis is based on clinical features and confirmatory imaging and pressure studies.

  • Headache (daily, pressure-like)
  • Pulsatile tinnitus
  • Visual disturbances (transient obscurations, diplopia, papilledema)
  • Elevated intracranial pressure (ICP) signs
  • First-line, non-invasive
  • Findings:
    • Transverse/sigmoid sinus narrowing
    • Collateral venous channels
    • Optic nerve sheath distension
    • Posterior globe flattening
  • High-resolution anatomical detail
  • Useful at bone-venous interfaces (e.g., transverse-sigmoid junction)
  • Gold standard
  • Allows dynamic assessment of:
    • Sinus anatomy
    • Trans-stenotic pressure gradient
      • A gradient ≥ 4 mmHg = hemodynamically significant stenosis
  • Functional stenosis requires:
    • Anatomical narrowing on imaging AND
    • Elevated trans-stenotic gradient on manometry
  • Arachnoid granulations (benign filling defects)
  • Sinus hypoplasia (anatomic variant)
  • Cerebral venous thrombosis
  • Secondary sinus collapse due to raised ICP
Modality Findings Role
MRI/MRV Sinus narrowing, optic sheath distension First-line screening
CT Venography Confirms anatomy, good bone detail Complementary study
DSA + Manometry Direct visualization, pressure gradient measurement Definitive diagnosis
  • venous_sinus_stenosis_diagnosis.txt
  • Last modified: 2025/07/01 13:43
  • by administrador