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Cerebral venous disorders: the path forward
  1. Kyle M Fargen1,
  2. Ferdinand Hui2,
  3. Joshua A Hirsch3
  1. 1 Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
  2. 2 Neuroscience Institute, Division of Neurointerventional Surgery, Queen's Medical Center, Honolulu, Hawaii, USA
  3. 3 Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Kyle M Fargen, Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA; kfargen{at}wakehealth.edu

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Arterial diseases are well understood to be major causes of morbidity and mortality. High pressured arteries carry blood, oxygen, and other ‘fuels’ for organ function. In contrast, the waste clearance mechanisms for the body are much less understood. Increasingly, disorders of the body’s waste system are being investigated as they may be the etiology of conditions previously described as ‘idiopathic.’ It is now recognized that impairments in cerebral venous outflow may cause headaches and visual symptoms that are more than simply burdensome. Rather, they have been linked to potentially dramatic impairments in functional capacity, quality of life, and cognitive function that may be to varying extents reversible with treatment.1–3

On January 12–13, 2023, the newly formed Society of Neurointerventional Surgery (SNIS) Cerebral Venous and Cerebrospinal Fluid (CSF) Disorders Committee held its inaugural conference in Honolulu, Hawaii, USA. Roughly 30 attendees from three countries, from industry and academia, including biomedical engineering, vascular surgery, hydrodynamic neurological surgery, spine neurosurgery, skull base neurosurgery, neurointervention, neurology, neurocritical care, and otolaryngology gathered to discuss the burgeoning, interrelated field of cerebral venous and CSF diseases.

The Committee was formed from a universal recognition of need among experts specializing in primary venous disorders of the brain. For instance, the standard-bearer for these conditions, the likely ‘misnamed’ idiopathic intracranial hypertension (IIH) with associated venous sinus stenosis, remains poorly understood and evidenced, even though venous sinus stenting incidence is on the rise.4 There are no published guidelines for patient selection or management, no published randomized trials evaluating treatment modalities, limited cooperative registry efforts to provide high-powered or quality data on outcomes, few technologies developed specifically for dural catheterization or stenting, limited organized patient referral networks or support resources, and no specific procedural codes to facilitate tracking and define appropriate compensation for specific interventions. Other less common primary venous disorders such as venous pulsatile tinnitus, CSF-venous fistulae, or jugular stenosis are seemingly more basic in terms of evidence, cooperation, technological innovation, patient resources, and coding.

The Cerebral Venous and CSF Disorders Committee aims to provide thought leadership for the SNIS on the science, regulatory, device innovation, and clinical trials related to these disease processes. For the initial year, the Committee intends to apply for a hierarchical International Classification of Diseases, 10th Revision (ICD-10) code; organize white papers for cerebral venography, transverse sinus stenting, and diagnostic cerebral venography; and organize registries for procedures currently being performed. Patient portals, education, and other clinical resources will follow.

The inaugural Cerebral Venous and CSF Disorders Committee conference comes at a time when JNIS content focused on venous pathology and interventions is on the rise (table 1). This increase in venous disorder submissions also comes with an expansion in the breadth of subjects. For instance, in the most recent calendar year (2022), JNIS featured a total of 14 manuscripts focused on a diverse set of venous disorder topics including IIH and venous sinus stenting,5 6 dural venous anatomy and catheterization techniques,7 venous sinus thrombosis and thrombectomy,8–10 venous pulsatile tinnitus,11 12 CSF-venous fistulae treatment,13–15 the treatment of symptomatic internal jugular vein stenosis,16 and even the first in-human publication using a transvenous endovascular CSF shunt.17 18

Table 1

JNIS publications focused on primary venous disorders by year

The Cerebral Venous and CSF Disorders Committee welcomes the involvement of SNIS members to forge new research, partnerships, and therapeutic strategies for these challenging patients. Increasingly, venous disease is associated with cognitive dysfunction; perhaps as we live longer, we will find that the health of the brain’s waste clearance is critical to brain function and longevity.19

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References

Footnotes

  • Twitter @JoshuaAHirsch

  • Contributors All authors contributed equally.

  • 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 Commissioned; internally peer reviewed.