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Changes in mean arterial pressure and end-tidal carbon dioxide content affect venous sinus pressures in patients with idiopathic intracranial hypertension: a randomized study
  1. Christine Tschoe1,
  2. Rebecca M Garner1,
  3. Carol Kittel2,
  4. Justin R Traunero3,
  5. Stacey Q Wolfe1,
  6. Kyle M Fargen1
  1. 1Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  2. 2Division of Public Health Sciences, Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  3. 3Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
  1. Correspondence to Dr Christine Tschoe, Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; ctschoe{at}


Introduction Little is known about how changes in physiologic parameters affect venous sinus pressure measurements, waveforms, or gradients associated with sinus stenosis.

Objective To evaluate the effect of changes in cardiovascular and respiratory physiologic parameters on venous sinus pressure and caliber measurements in patients with idiopathic intracranial hypertension (IIH) undergoing venous sinus stenting.

Methods In a prospective, randomized pilot study, eight patients with IIH undergoing venous sinus stenting were randomized to one of two groups. Under general anesthesia, patients underwent venous manometry and waveform recordings twice in succession based on assigned physiologic groups immediately before stenting. The mean arterial pressure (MAP) group maintained normocapnia but modified MAPs in two arms to control for temporal confounding: group A1 (MAP 60-80 mm Hg then 100–110 mm Hg) and group A2 (MAP 100-110 mm Hg then 60–80 mm Hg). The end-tidal carbon dioxide (EtCO2) group maintained a high-normal MAP similar to standard neuroanesthesia goals and modified EtCO2: group B1 (EtCO2 24–26 mm Hg then 38–40 mm Hg) and B2 (EtCO2 28–40 mm Hg then 24–26 mm Hg).

Results In group A, superior sagittal sinus (SSS) pressures (ranging from 8 to 76 mm Hg) and trans-stenotic pressure gradients (TSPGs) (ranging from 2 to 67 mm Hg) were seen at MAP of 100–110 mm Hg compared with SSS pressures (4–38 mm Hg) and TSPGs (3–31 mm Hg) at 60–80 mm Hg. In group B, SSS pressures and TSPGs were considerably higher at EtCO2 levels of 38–40 mm Hg (15–57 mm Hg and 3–44 mm Hg, respectively) than at 24–26 mm Hg (8–26 mm Hg and 1–8 mm Hg, respectively).

Conclusions Despite the small sample size, this pilot study demonstrates a dramatic effect of both MAP and EtCO2 on venous sinus pressures obtained during venography. These findings underscore the importance of maintaining normal physiologic cardiovascular and respiratory parameters during venous sinus manometry.

  • intracranial pressure
  • stenosis
  • angiography
  • blood pressure
  • stent

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  • Contributors CT: data collection, data analysis, manuscript preparation. RMG: data collection, manuscript preparation. CK: design, data analysis. JRT: data collection, manuscript preparation. SQW: conception, design, data collection, manuscript preparation. KMF: conception, study design, data collection, data analysis, manuscript preparation.

  • 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.

  • Patient consent for publication Not required.

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

  • Data availability statement Unpublished data are available upon request from the corresponding author.