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Case series
Intracranial venous pressures under conscious sedation and general anesthesia
  1. Daniel M S Raper1,
  2. Thomas J Buell1,
  3. Ching-Jen Chen1,
  4. Dale Ding1,
  5. Robert M Starke2,
  6. Kenneth C Liu1,3
  1. 1Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
  2. 2Deparment of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
  3. 3Department of Radiology, University of Virginia Health System, Charlottesville, Virginia, USA
  1. Correspondence to Dr Kenneth C Liu, Department of Neurosurgery, University of Virginia Health System, Box 800212, Charlottesville, VA 22908, USA; kcl3j{at}hscmail.mcc.virginia.edu

Abstract

Introduction Venous outflow obstruction has been implicated in the pathophysiology of a subset of patients with idiopathic intracranial hypertension (IIH), and venous sinus stenting (VSS) has emerged as an effective treatment. However, the effect of anesthesia on venous sinus pressure measurements is unpredictable. A more thorough understanding of the effect of the level of anesthesia on intracranial venous pressures might help to better define patients who might benefit most from stent placement.

Objective To compare, in a retrospective cohort study, intracranial venous pressures measured under conscious (CS) sedation versus general anesthesia (GA) and to assess the relationship between anesthetic-dependent venous pressures and outcomes after VSS.

Methods We performed a retrospective review of a prospectively maintained database to identify patients undergoing angiographic evaluation and VSS for intracranial venous stenosis. Mean venous pressures (MVPs) and trans-stenosis pressure gradients obtained under CS were compared with those measured under GA.

Results The maximal MVP was significantly lower under GA (19.8 mm Hg) than CS (21.9 mm Hg; p=0.029). The MVPs in the superior sagittal sinus, torcula, and transverse sinus were lower under GA, but were significantly higher in the sigmoid sinus and jugular bulb under GA (p<0.001). The mean trans-stenosis pressure gradient was also significantly lower under GA (8.6 mm Hg) than CS (12.1 mm Hg; p<0.001). Patients with a larger difference between maximum MVP under GA versus CS were more likely to have normalization of the MVP after VSS (p=0.0008).

Conclusions Intracranial venous pressures are markedly affected by GA. In order to obtain an accurate measurement of MVPs and trans-stenosis gradients, patients undergoing investigation for IIH should undergo cerebral angiography and venous manometry under CS, which provides more reliable data for outcomes after VSS.

  • Angiography
  • Intracranial Pressure
  • Stenosis
  • Stent
  • Vein

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Footnotes

  • Contributors DMSR conceived the study, performed data analysis, drafted the manuscript, and approved the final version of the manuscript. TJB, DD assisted in data analysis, critically revised the manuscript, and approved the final version of the manuscript. C-JC, RMS critically revised the manuscript, and approved the final version of the manuscript. KCL contributed to the design of the study, oversaw data collection and analysis, critically revised the manuscript, and approved the final version of the manuscript.

  • Competing interests None declared.

  • Ethics approval University of Virginia Institutional Review Board for Health Sciences Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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