Correlation between intracranial pressure and venous sinus pressures in patients undergoing cerebral venography and manometry.

BACKGROUND: The pathophysiology of idiopathic intracranial hypertension (IIH) is complex but is directly related to cerebral venous hypertension. Few studies have simultaneously recorded venous sinus pressures and lumbar puncture (LP) opening pressure (OP) to understand the relationship between these factors without temporal confounding.
METHODS: A retrospective review was performed of patients with a known or suspected diagnosis of IIH who underwent cerebral venography with manometry followed immediately by LP.
RESULTS: 47 patients aged 16-68 years met inclusion criteria. 91.5% were female. Mean body mass index (BMI) was 33.3 kg/m2. Of the included patients, median OP was 21 cm H2O (IQR (15.5, 26.5)). Mean (SD) recorded superior sagittal sinus (SSS) and torcular pressures were 25.5 (16.5) mm Hg and 23.8 (16.6) mm Hg, respectively. Twenty patients (42.6%) were discovered to have a trans-stenosis gradient of 8 mm Hg or greater. Transverse sinus, torcula, and SSS pressures were all significantly predicted by OP. On regression analysis, torcular pressures were best predicted by OP of the three measured sites. For 17 patients with OP <20 cm H2O (36.2%), mean (SD) SSS and torcular pressures were 13.5 (4.2) mm Hg and 15.4 (6.7) mm Hg, respectively, suggesting that normally SSS pressures should measure <18 mm Hg (80th percentile) in non-pathologic conditions.
CONCLUSIONS: This is the first study to correlate venous sinus pressures and OP in patients with IIH with LP performed directly after manometry. In 47 patients, LP OP significantly predicted transverse sinus, torcula, and SSS pressures. Torcular pressures (mm Hg) were most accurately predicted by OP (cm H2O) in a nearly one-to-one relationship. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.