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Original research
Anatomical characterization of the inferior petrosal sinus and adjacent cerebellopontine angle cistern for development of an endovascular transdural cerebrospinal fluid shunt
  1. Carl B Heilman1,2,
  2. Gregory W Basil2,
  3. Brandon M Beneduce3,
  4. Adel M Malek1,2
  1. 1 Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
  2. 2 Tufts University School of Medicine, Boston, Massachusetts, USA
  3. 3 CereVasc LLC, Auburndale, Massachusetts, USA
  1. Correspondence to Dr Adel M Malek, Cerebrovascular and Endovascular Division, Department of Neurosurgery, Tufts Medical Center, Boston MA 02111, USA; amalek{at}tuftsmedicalcenter.org

Abstract

Background and purpose We evaluated the inferior petrosal sinus (IPS) and adjacent cerebellopontine angle (CPA) cistern as a potential implantation site for a novel venous endovascular transdural CSF shunt concept to treat communicating hydrocephalus. We analyzed the dimensions of the IPS, CPA cistern, and distances to adjacent neurovascular structures.

Materials and methods Gadolinium enhanced T1 weighted brain MRI datasets of 36 randomly selected patients, aged 20–80 years, were analyzed with three-dimensional multiplanar reconstruction to measure IPS diameter and length, CPA cistern depth, and IPS proximity to the vertebrobasilar arteries and brainstem. Statistical analysis was used to assess gender, sidedness, and age dependence.

Results Mean IPS diameter ranged from 2.27 mm to 3.31 mm at three axial levels, with >90% larger than 1.46 mm. CPA cistern adjacent to the IPS exhibited a mean depth of 3.86 mm to 7.39 mm between the dura and brainstem at corresponding axial levels. There was no side dependence except for a longer distance from the IPS to the basilar artery on the left compared with the right (9.72 vs 7.28, P<0.019). Linear regression analysis showed that the distance from the IPS to the brainstem was statistically significantly increased with age (P<0.0002) and was greater in men, with little side variation (P=0.524).

Conclusion Our results demonstrate sufficient CSF CPA cisternal space adjacent to the IPS and support the feasibility of an endovascular catheter delivered transdural implantable shunt. Such a device could serve to mimic the function of the arachnoid granulation by establishing a regulated path for CSF flow from the intracranial subarachnoid space to the venous system and provide a treatment for communicating hydrocephalus.

  • hydrocephalus
  • endovascular shunt
  • transvenous therapy
  • inferior petrosal sinus

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Footnotes

  • Contributors The image was obtained from the Rhoton collection and appropriately referenced as recommended by the source.

  • Funding CereVasc LLC provided research stipend support to GWB for this study.

  • Competing interests AMM and CBH are co-founders and investors of CereVasc, LLC. AMM, CBH, and BMB are shareholders of CereVasc, LLC.

  • Patient consent Not required.

  • Ethics approval The study was approved by Tufts Health Sciences Campus institutional review board.

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

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