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Total brain volume is associated with severity of transverse sinus stenosis in idiopathic intracranial hypertension
  1. Derrek Schartz1,
  2. Alan Finkelstein1,
  3. Sajal Medha K Akkipeddi2,
  4. Alex Kessler1,
  5. Zoe Williams3,
  6. Edward Vates2,
  7. Erik F Hauck4,
  8. Kyle M Fargen5,
  9. Matthew T Bender2
    1. 1Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
    2. 2Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
    3. 3Ophthalmology, University of Rochester Medical Center, Rochester, New York, USA
    4. 4Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
    5. 5Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
    1. Correspondence to Dr Derrek Schartz, Imaging Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA; derrek_schartz{at}


    Background Idiopathic intracranial hypertension (IIH) is a complex neurological condition characterized by symptoms of increased intracranial pressure of unclear etiology. While transverse sinus stenosis (TSS) is often present in patients with IIH, how and why it occurs remains unclear.

    Methods IIH patients and a set of age-matched normal controls were identified from our single-center tertiary care institution from 2016 to 2024. Brain MRIs before treatment were computationally segmented and parcellated using FreeSurfer software. Extent of TSS on MR venograms was graded using the Farb scoring system. Relationship between normalized brain volume, normalized brain-to-CSF volume, and TSS was investigated. Multiple linear regression was conducted to investigate the association between continuous variables, accounting for the covariates body mass index, sex, and age.

    Results In total, 84 IIH patients (mean age, 29.8 years; 87% female) and 15 normal controls (mean age, 28.1 years) were included. Overall, increasing/worsening TSS was found to be significantly associated with normalized total brain volume (p=0.018, R=0.179) and brain-to-CSF ratio volume (p=0.026, R=0.184). Additionally, there was a significant difference between controls and IIH patients with mild and severe stenosis regarding normalized total brain volume (ANCOVA, p=0.023) and brain-to-CSF ratio volume (ANCOVA, p=0.034). Likewise, IIH patients with severe TSS had a significantly higher brain-to-CSF volume compared with controls (p=0.038) and compared with IIH patients with mild TSS (p=0.038).

    Conclusions These findings suggest that total brain volume is associated with extent of TSS, which may reflect extramural venous compression due to enlarged brain and/or venous hypertension with associated cerebral congestion/swelling.

    • Brain
    • Intracranial Pressure
    • MRI

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    • DS and AF are joint first authors.

    • X @D_SchartzMD, @SajalAkkipeddi

    • DS and AF contributed equally.

    • Contributors Study conception and design: DS, AF, MTB, KMF. Data collection: DS, AF, AK. Data analysis: DS, AF. Data interpretation: all authors. Primary manuscript writing: DS, AF, KMF, MTB. Manuscript editing and revisions: all authors. DS, AF, and MTB are guarantors.

    • 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 KMF serves on the editorial board of Journal of NeuroInterventional Surgery (JNIS). Otherwise, there are no additional competing interests.

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