Article Text

Download PDFPDF
Original research
Angiographic cerebral venous sinus calibers and drainage patterns in patients with normal intracranial pressure and idiopathic intracranial hypertension
  1. Keyan A Peterson1,
  2. Carol Kittel2,
  3. Katriel E Lee1,
  4. Rebecca Garner1,
  5. Carl Mandel Nechtman1,
  6. Patrick Brown3,
  7. Stacey Q Wolfe1,
  8. Kyle M Fargen1
  1. 1 Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2 Division of Public Health Sciences, Department of Biostatistics, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
  3. 3 Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  1. Correspondence to Keyan A Peterson, Department of Neurological Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157-0001, USA; kapeters{at}


Background Normative venous sinus diameters are not well established. This study seeks to compare two-dimensional digital subtraction cerebral angiographic (DSA) venous sinus calibers for patients with normal intracranial pressure (ICP) and with idiopathic intracranial hypertension (IIH).

Methods Patients who underwent diagnostic cerebral angiography from 2016 to 2020 were retrospectively identified. Two independent reviewers measured venous sinus calibers from anteroposterior (AP) and lateral carotid injection delayed venous phase in patients from two groups (group 1: patients with normal ICP; group 2: patients with IIH) after receiving training in a standardized measurement protocol, with measurements obtained from the superior sagittal sinus (SSS) through the sigmoid sinuses (SS).

Results 97 patients from group 1 and 30 patients from group 2 were included. Interrater reliability was greater than 0.75 for all measured sites. Both groups had similar anatomical subtypes with most being right transverse sinus (TS) dominant or codominant. In group 1, men had significantly larger SSS on lateral view (p<0.001) and dominant TS calibers on AP view (p=0.02) compared with women. Both dominant TS measurements and SSS measurements (lateral plane) were significantly smaller among group 2 compared with group 1 (p<0.001 and 0.02, respectively). Patients with IIH had significantly larger dominant SS measurements (p=0.01). Bifid SSS anatomy was present in 9% of patients with mean caudal width 31 mm (range 19–49 mm).

Conclusions This study is the first to provide two-dimensional DSA dural venous sinus calibers in patients with and without IIH and to compare anatomical drainage types and calibers among groups.

  • intracranial pressure
  • standards
  • blood flow
  • angiography

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • Contributors KAP: data collection, drafting, revision. CK: data analysis, drafting, revision. KEL: data collection, revision. RG: data collection, revision. CMN: data collection, revision. PB: data analysis, drafting, revision. SQW: revision. KMF: conceptualization, data analysis, drafting, revision.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.