What is Dural Venous Sinus Stenosis (Dural Venous Stenosis)?

From the Guidelines

Dural venous stenosis is a narrowing of the dural venous sinuses, which can lead to increased intracranial pressure and is often associated with idiopathic intracranial hypertension (IIH). This condition is characterized by anatomical abnormalities of the cerebral venous sinus system, including stenosis of the dominant or both transverse sinus, as reported in a study published in the Journal of Neurology, Neurosurgery and Psychiatry in 2018 1. The stenosis may result from intrinsic dural sinus anatomy or extrinsic compression by the increased intracranial pressure, and reducing ICP can lead to resolution of stenosis.

Some key points to consider about dural venous stenosis include:

• The degree of stenosis does not appear to uniformly correlate with intracranial pressure or visual loss, as noted in the study 1
• Neurovascular stenting has been reported to lead to an improvement in symptoms of intracranial hypertension, but the role of neurovascular stenting in IIH is not yet established 1
• Complications of the procedure include a short-lived ipsilateral headache, stent-adjacent stenosis, vessel perforation, stent migration, and thrombosis, highlighting the need for careful consideration and management 1
• Long-term antithrombotic therapy is required for longer than 6 months following neurovascular stenting treatment, to minimize the risk of complications 1

In terms of diagnosis and treatment, magnetic resonance venography (MRV) or computed tomography venography (CTV) are commonly used to visualize the venous structures and diagnose dural venous stenosis. Treatment may include medical management with acetazolamide or topiramate to reduce intracranial pressure, weight loss for overweight patients, and in severe cases, venous sinus stenting to widen the narrowed area and improve blood flow. Overall, dural venous stenosis is a complex condition that requires careful diagnosis and management to prevent complications and improve patient outcomes.

From the Research

Definition and Overview of Dural Venous Stenosis

• Dural venous stenosis refers to the narrowing of the dural venous sinuses, which are channels found between the layers of the dura mater that surround the brain and spinal cord 2, 3.
• This condition can lead to increased intracranial pressure, resulting in symptoms such as headaches, visual disturbances, and papilledema 2, 4.

Causes and Pathophysiology

• The exact causes of dural venous stenosis are not fully understood, but it is thought to be related to various factors, including increased pressure in the dural venous sinuses and transmission of increased abdominal pressure to the cerebral draining veins 3.
• Dural venous sinus stenosis has been proposed as a treatable cause of idiopathic intracranial hypertension (IIH), a condition characterized by elevated intracranial pressure without radiographic evidence of a mass lesion in the brain 2, 4.

Diagnosis and Treatment

• Diagnosis of dural venous stenosis typically involves imaging studies such as MR venography and cerebral angiography 2, 4.
• Treatment options for dural venous stenosis include endovascular stenting, which has been shown to be effective in improving symptoms and reducing intracranial pressure in patients with IIH 2, 4.
• Other treatment options, such as anticoagulation and thrombolysis, may also be considered in certain cases 5, 6.

Clinical Outcomes and Complications

• Studies have reported significant improvement in symptoms and reduction in intracranial pressure following endovascular stenting for dural venous stenosis 2, 4.
• However, complications such as intracranial hemorrhage and re-stenosis can occur, highlighting the need for careful patient selection and follow-up 6, 4.