Venous sinus obstruction in PTS is a more common factor in the pathogenesis of the condition than previously recognised. Venous sinus obstruction usually occurs around the junction of the middle and distal thirds of the transverse sinus and is often bilaterally symmetrical. Venous obstruction may be primary, that is, it is the underlying aetiological factor of PTS. Venous sinus obstruction may also be secondary to raised CSF pressure. The latter may exacerbate problems with intracranial compliance and raised CSF pressure. Venous sinus obstruction does not only occur in thin patients but occurs across the spectrum of PTS patients including young overweight females.
In the investigation of PTS, the index of suspicion for venous sinus obstruction should be high. Examinations should not only exclude thrombotic obstruction but should also focus on detecting venous sinus obstruction, especially in the region of the transverse and sigmoid sinuses. Static MR and contrast-enhanced MR venography are the most useful non-invasive investigations for this purpose and should be performed in all patients with PTS. Patients with PTS should preferably undergo DRCV with manometry. This should be performed in all patients who are considered for non-medical therapy whether or not an obstruction has been demonstrated on MR imaging. Venography with manometry will also diagnose systemic venous hypertension.
Treatment for cases of PTS with venous sinus obstruction should be medical initially. In cases where clinical PTS and raised CSF pressure persist or if vision is threatened, consideration should be given to other treatments. Figure 14 provides a useful scheme for the interpretation of veno-graphic and manometric studied and may be used as a guide to therapy. Venous sinus stenting should be considered as a first-line option in cases of venous sinus obstruction with associated pressure gradients, especially where the obstruction appears to intrinsic. For patients with extrinsic compression, venous sinus stenting may still be effective, especially in the instance of disordered feedback loops and should be considered as a viable treatment alternative to other forms of surgical management including CSF shunting.
Was this article helpful?
Do You Suffer From High Blood Pressure? Do You Feel Like This Silent Killer Might Be Stalking You? Have you been diagnosed or pre-hypertension and hypertension? Then JOIN THE CROWD Nearly 1 in 3 adults in the United States suffer from High Blood Pressure and only 1 in 3 adults are actually aware that they have it.