Background The etiology of transverse sinus stenosis in patients with pseudotumor cerebri syndrome (PTCS) is unknown. The imaging findings of transverse sinus stenosis in two patients with PTCS using intravascular ultrasound (IVUS) before and after endovascular therapy with stent placement are reported.

Material and methods Retrospective, two patient, technical note.

Results In both cases IVUS demonstrated focal intraluminal filling defects within the transverse sinuses, resulting in a narrowing of the sinus. In the first case, IVUS demonstrated cannulation of a narrow channel within the transverse sinus that initially precluded advancement of the stent. In the second case, IVUS demonstrated a significant narrowing when the pressure gradient was borderline and the area of stenosis was not obvious at angiography.

Conclusion Besides distinguishing a potential extrinsic compression phenomenon from an intrinsic abnormality as the cause of the transverse sinus stenosis, IVUS also shows great promise as a tool helping to plan the interventional procedure and achieve optimal stent positioning in patients with PTCS.