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Original research
A descriptive study of venous sinus pressures and gradients in patients with idiopathic intracranial hypertension
  1. Kyle M Fargen,
  2. Rebecca M Garner,
  3. Carol Kittel,
  4. Stacey Q Wolfe
  1. Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Kyle M Fargen, Neurosurgery, Wake Forest University, Winston-Salem, NC 27157, USA; kfargen{at}


Objective To determine the relationship between normal physiologic and pathologic venous sinus pressures in patients with idiopathic intracranial hypertension (IIH), which is poorly understood.

Methods Retrospective analysis was performed to identify patients with medically refractory IIH who were evaluated by angiography and retrograde venography with venous manometry. Patients were further subdivided into groups based on anatomic factors.

Results 104 patients met inclusion criteria for the study. In the absence of non-invasive venographic screening, 58% of patients in this series were found to have pressure gradients of ≥8 mm Hg; 93% were located near the transverse-sigmoid sinus junction. Opening pressure (OP) is strongly predictive of superior sagittal sinus (SSS) pressures (p<0.001) and also of the presence of a pressure gradient ≥8 mm Hg (p<0.001). Twenty-three percent of patients with an OP <25 had a pressure gradient ≥8 mm Hg compared with 77% of patients with an OP ≥35. Analysis of patients with OP ≤20 suggests that SSS pressures in patients without IIH should be less than 16–18 mm Hg with total cranial gradients <5 mm Hg. Across all patients, a pressure decrement of approximately 1 mm Hg occurs with progressively more caudal transition across anatomic points of measurement.

Conclusions This study describes intracranial and extracranial venous pressure measurements and gradients in different subgroups of patients with IIH. OP is highly predictive of intracranial venous pressures and significant venous pressure gradients.

  • idiopathic intracranial hypertension
  • pseudotumor cerebri
  • venous sinus stenting

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  • Contributors Concept design: KMF. Data collection: RMG. Data review: KMF, CK, SQW. Manuscript composition: KMF, SQW, RMG. Final approval of article: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval IRB00042737.

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

  • Data sharing statement There are no additional data available.

  • Patient consent for publication Not required.