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Original research
A descriptive study of venous pressures and gradients while awake and both pre- and post-stent under anesthesia in patients with idiopathic intracranial hypertension
  1. Kyle M Fargen1,
  2. Stacey Q Wolfe1,
  3. Justin R Traunero2,
  4. Ankitha M Iyer1,
  5. Carol Kittel3
  1. 1Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
  2. 2Anesthesiology, Wake Forest University, Winston-Salem, North Carolina, USA
  3. 3Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Kyle M Fargen, Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, NC 27157, USA; kfargen{at}wakehealth.edu

Abstract

Background This study aims to explore factors that affect venous sinus pressures and associated gradients while awake and under general anesthesia (GA) both before and after venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH).

Methods A retrospective analysis was performed examining pressures and gradients in patients with IIH having undergone awake venography followed by VSS under GA.

Results 174 patients were included. Compared with awake, GA superior sagittal sinus (SSS) pressures were 2.6 mmHg lower (p=0.01) resulting in a total cranial gradient reduction of 2.5 mmHg (p=0.002). The transverse-sigmoid gradient, the most commonly stented segment, did not differ under the two conditions (p=0.30). Regression analyses demonstrated that body mass index, gender, blood pressure, and end-tidal carbon dioxide content significantly affected venous pressures (all p<0.05). After stenting, mean total cranial gradients decreased by 13.2 mmHg while skull base gradients increased by 0.8 mmHg. Stenting resulted in an 84% mean reduction in the target gradient and a mean decrease in SSS pressures by 78% of the target gradient. When cardiopulmonary and anesthetic factors were optimized, GA had a limited effect on the target gradient in most patients (p=0.88).

Conclusions This study is the largest series to date to report on cerebral venous pressure measurements and gradients recorded while awake and under GA both before and after VSS for IIH. In a well-controlled cardiorespiratory and anesthetic setting, GA venography may provide information that is not substantially inequivalent to that obtained while awake.

  • Intracranial Pressure
  • Stent
  • Stenosis
  • Vein

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors Concept: KMF. Data acquisition: KMF, JRT, AMI. Statistical analysis: CK. Manuscript composition: All authors. Guarantor: KMF.

  • 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.