Nuances of Endovascular Treatment of Transverse/Sigmoid Sinus Stenosis With Stenting Venoplasty in a Patient With Pseudotumor Cerebri: 2-Dimensional Operative Video

被引:0
|
作者
Rangel-Castilla, Leonardo [1 ,3 ,4 ]
Siddiqui, Adnan H. [1 ,2 ,3 ,5 ,6 ]
机构
[1] SUNY Buffalo, Jacobs Sch Med & Biomed Sci, Dept Neurosurg, Buffalo, NY USA
[2] SUNY Buffalo, Jacobs Sch Med & Biomed Sci, Dept Radiol, Buffalo, NY USA
[3] Kaleida Hlth, Gates Vasc Inst, Dept Neurosurg, Buffalo, NY USA
[4] Mayo Clin, Dept Neurosurg, Rochester, MN USA
[5] SUNY Buffalo, Canon Stroke & Vasc Res Ctr, Buffalo, NY USA
[6] Jacobs Inst, Buffalo, NY USA
关键词
Pseudotumor cerebri; Sigmoid sinus; Sinus stenosis; Stenting venoplasty; Transverse sinus;
D O I
10.1093/ons/opy174
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
We present a case of a patient with pseudotumor cerebri (PC) and transverse/sigmoid junction sinus (TSJS) stenosis treated with stenting venoplasty. A 54-yr-old man with a history of hypertension, hyperlipidemia, and chronic obstructive pulmonary disease presented with subacute onset of progressive headaches, blurred vision, and papilledema. He was clinically diagnosed with PC. Left TSJS stenosis was suspected on magnetic resonance venography and confirmed with digital subtraction angiography and venography. During angiography, venous pressures were measured along the intracranial venous system revealing a significant drop compared with pressures obtained from the superior sagittal and sigmoid sinuses. For 7 d prior to venous sinus stenting, he was prescribed antiplatelet therapy with aspirin (350 mg/d) and clopidogrel (75 mg/d). Patient consent was obtained prior to performing the procedure; institutional board approval is not required for the report of a single case. Under conscious sedation and systemic heparinization, the patient underwent endovascular stenting of the left TSJS with an open-cell carotid stent (Precise 7 x40 mm; Cordis, Milpitas, California). Successful left TSJS reconstruction transpired with no procedure-related complications. The patient was discharged home 1 d postprocedure. After 2 mo of dual antiplatelet therapy, clopidogrel was discontinued. At the 1-yr follow-up, he had resolution of papilledema and notably less intense headaches. Venous sinus stenting is an effective endovascular treatment for symptomatic patients with PC and sinus stenosis. Venous pressure measurement is imperative for patient selection. Adequate venous access with a 6-French guide catheter into the sigmoid sinus and an intermediate catheter into the transverse sinus is crucial to navigate a stent through the acute angles of the TSJS and jugular vein.
引用
收藏
页码:393 / 394
页数:2
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