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We read with interest the recent paper looking at venous sinus pressure gradients prior to stenting (1), and commend the authors for their work on this interesting topic. We also share an interest in the subject, and recently published our experience looking at venous stenting in a similar patient population (2). The authors of the current paper documented significant differences in trans-stenotic venous pressure-gradients measured under general anaesthesia (GA), and suggested that pressure measurements should be performed with patients awake to counteract this. Another paper published in this issue of JNIS also documented the disparities between pressure measurements performed under GA versus those performed under conscious sedation (CS) (3). The pressure differences in our paper were significantly more marked in those patients who underwent measurements under local anaesthesia alone versus under CS. We can therefore hypothesise that even the use of CS can result in changes in the measured venous pressures in these patients, and indeed in the current paper the authors noted that the use of midazolam in their awake patients had a statistically significant effect on the pressures obtained. Since the decision to treat often hinges on this all-important measurement, we thus propose that venous sinus pressure measurements should be always performed using local anaesthesia alone, in an effort to minimise this variability.
1: Fargen KM, Spiotta AM, Hyer M, et al, Comparis...
1: Fargen KM, Spiotta AM, Hyer M, et al, Comparison of venous sinus manometry gradients obtained while awake and under general anesthesia before venous sinus stenting. Journal of NeuroInterventional Surgery 2017;9:990-993
2: Lenck S, Vallée F, Labeyrie MA et al, Stenting of the lateral sinus in idiopathic intracranial hypertension according to the type of stenosis. Neurosurgery. 2017 Jan 13;80(3):393-400
3: Raper DMS, Buell TJ, Chen C, et al, Intracranial venous pressures under conscious sedation and general anesthesia Journal of NeuroInterventional Surgery 2017;9:986-989