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Head and neck
Original research
Cerebral venous pressures, sinus trans-stenosis gradients, and intracranial pressures are dramatically augmented by head position
  1. Kyle M Fargen1,
  2. Jackson P Midtlien1,
  3. Connor R Margraf1,
  4. Angelina H Wiater1,
  5. Paul A Marcet1,
  6. Adnan H Siddiqui2,
  7. Ferdinand Hui3
    1. 1Department of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
    2. 2Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
    3. 3Department of Neurointerventional Surgery, Queen's Medical Center, Honolulu, Hawaii, USA
    1. Correspondence to Jackson P Midtlien; jmidtlie{at}wakehealth.edu

    Abstract

    Background Cerebral venous pressures, sinus trans-stenosis gradients, and intracranial pressures are thought to be influenced by head position.

    Objective To investigate the intracranial manifestations of these changes in patients with cerebral venous outflow disorders (CVD).

    Methods A retrospective chart review was conducted on 22 consecutive adult patients who underwent diagnostic cerebral venography with rotational internal jugular vein (IJV) venography and superior sagittal sinus (SSS) pressure measurements in multiple head positions. Data on venous sinus pressures, IJV pressures, and lumbar puncture (LP) opening pressures (OP) were collected and analyzed.

    Results The study found that 21 (96%) patients experienced increases in SSS pressures with head rotation, with a mean increase of 25.4%. Intracranial trans-stenosis gradients showed significant variability with head position. Additionally, LP OP measurements increased by an average of 44.3% with head rotation. Dynamic IJV stenosis was observed in all patients during rotational testing.

    Conclusion Head position significantly affects cerebral venous pressures, trans-stenosis gradients, and intracranial pressures in patients with CVD or intracranial hypertension. These findings highlight the need for dynamic venography in the diagnostic evaluation of these conditions to better understand their pathophysiology and improve treatment strategies.

    • Intracranial Pressure
    • Standards
    • Stenosis
    • Technique
    • Vein

    Data availability statement

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

    https://doi.org/10.1136/jnis-2024-022167

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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 KMF: conception and design of the study, analysis and interpretation of data, drafting and revising the article, and guarantor of the study. JPM: conception and design of the study, data collection, manuscript drafting and revising, analysis and interpretation of data. CM: conception and design of the study, data collection, manuscript drafting and revising, analysis and interpretation of data. AW: data collection and manuscript drafting. PM: data collection and manuscript drafting. AHS: conception and design of the study, drafting and revising the article. FH: conception and design of the study, drafting and revising the article.

      • 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 JNIS. NeuroVenous Technologies, ownership interest: KMF, AHS, and FH.

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