Endovascular Stenting for Chronic Headache Secondary to Cerebral Venous Sinus Stenosis A Case Report
Abstract
Highlight:
- CVSS is an underdiagnosed but reversible cause of chronic headache
- Venous stenting effectively restores venous outflow and reduces ICP
- Early recognition and intervention lead to rapid and sustained symptoms resolution
ABSTRACT
Introduction: Chronic headache poses a significant diagnostic and therapeutic challenge. Cerebral venous sinus stenosis (CVSS) is an underrecognized yet important etiology in which stenosis impairs venous outflow and elevates intracranial pressure, leading to headache. Endovascular stenting offers a therapeutic approach by mechanically restoring venous flow. Case: A 43-year-old female presented with a chronic headache for 3 months, refractory to multimodal medical therapy. Digital subtraction angiography (DSA) confirmed stenosis in the bilateral transverse sinuses. The patient subsequently underwent successful endovascular venous stenting. Conclusion: This case underscores that CVSS is a potentially treatable cause of chronic headache. Endovascular intervention can provide rapid symptomatic relief for patients with medically refractory headache secondary to venous sinus stenosis. Long-term follow-up remains essential to confirm sustained benefit.
Full text article
References
1. Steiner TJ. Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide. J Headache Pain. 2005;6:373-7. DOI: 10.1007/s10194-005-0241-7
2. Stovner LJ, Hagen K, Linde M, Steiner TJ. The global prevalence of headache : an update , with analysis of the influences of methodological factors on prevalence estimates. J Headache Pain. 2022;1–17. DOI: 10.1186/s10194-022-01402-2
3. Jia M, Guo Z, Jin H, Yan X, Shi M, Sun X, et al. Venous sinus stenting improves cerebral autoregulation in a patient with venous sinus stenosis : a case report. BMC Neurol. 2020;20(1):9. DOI: 10.1186/s12883-019-1595-9
4. Schaller B, Graf R. Cerebral Venous Infarction : The Pathophysiological Concept. Cerebrovasc Dis. 2004;18(3):179–88. DOI: 10.1159/000079939
5. McGeeney BE, Friedman DI. Pseudotumor Cerebri Pathophysiology. Headache. 2014;54(3):445-58. DOI: 10.1111/head.12291
6. Ahmed RM, Wilkinson M, Parker G, Thurtell MJ, MacDonald J, et al. Transverse Sinus Stenting for Idiopathic Intracranial Hypertension: A Review of 52 Patients and of Model Predictions. Am J Neuroradiol. 2011;32(8):1408-14. DOI: 10.3174/ajnr.A2575
7. Giridharan N, Patel SK, Ojugbeli A, Nouri A, Shirani P, et al. Understanding the complex pathophysiology of idiopathic intracranial hypertension and the evolving role of venous sinus stenting: a comprehensive review of the literature. Neurosurg Focus. 2018;45:E10. DOI: 10.3171/2018.4.FOCUS18100
8. Wall M. Idiopathic intracranial hypertension. Neurol Clin. 2010;28:593–617. DOI: 10.1016/j.ncl.2010.03. 003
9.. Mollan SP, Ali F, Hassan-Smith G, Botfield H, Friedman DI, et al. Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management. J Neurol Neurosurg Psychiatry. 2016;87:982–992. DOI: 10.1136/jnnp-2015-311 302
10. Abou-Mrad T, Alaraj A. Venous sinus stenosis intracranial hypertension, rethinking idiopathic intracranial hypertension in the setting of venous sinus stenosis: A call for new nomenclature and diagnostic precision. Interv Neuroradiol. 2024; 15910199241285754. DOI: 10.1177/15910199241 285754
11. Elder BD, Goodwin CR, Kosztowski TA, Radvany MG, Gailloud P, Moghekar A, et al. Venous sinus stenting is a valuable treatment for fulminant idiopathic intracranial hypertension. J Clin Neurosci. 2015;22(4):685–9. DOI: 10.1016/j.jocn.2014.10.012
12. Albuquerque FC, Dashti SR, Hu YC, Newman CB, Teleb M, et al. Intracranial Venous Sinus Stenting for Benign Intracranial Hypertension : Clinical Indications, Technique, and Preliminary Results. World Neurosurg. 2011;75(5-6):648–52. DOI: 10.1016/j.wneu.2010.11.012
13. Fields JD, Javedani PP, Falardeau J, Nesbit GM, Dogan A, Helseth EK, et al. Dural venous sinus angioplasty and stenting for the treatment of idiopathic intracranial hypertension. J Neurointerv Surg. 2013;5(1):62–8. DOI: 10.1136/neurintsurg-2011-010156
14. Puffer RC, Mustafa W, Lanzino G. Venous sinus stenting for idiopathic intracranial hypertension : a review of the literature. J Neurointerv Surg. 2013;5(5):483-6. DOI: 10.1136/neurintsurg-2012-010468
15. Boyter E. Idiopathic intracranial hypertension. JAAPA. 2019;32(5):30-35. DOI: 10.1097/01.jaa.0000554732.85914.91
16. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81(13):1159-65. DOI: 10.1212/wnl.0b013e3182a55f17
17. Morris PP, Black DF, Port J, Campeau N. Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension. Am J Neuroradiol. 2017;38(3):471-7. DOI: 10.3174/ajnr.a5055
18. Lim J, Monteiro A, Kuo CC, Jacoby WT, Cappuzzo JM, et al. Stenting for venous sinus stenosis in patients with idiopathic intracranial hypertension: An updated systematic review and meta-analysis of the literature. Neurosurgery. 2024;94(4):648-56. DOI: 10.1227/neu.0000000000002718
19. Raper D, Buell TJ, Ding D, Chen CJ, Starke RM, et al. Pattern of pressure gradient alterations after venous sinus stenting for idiopathic intracranial hypertension predicts stent adjacent stenosis: a proposed classification system. J Neurointerv Surg. 2018;10(4):391-395. DOI: 10.1136/neurintsurg-2017-013135
20. Nicholson P, Brinjikji W, Radovanovic I, Hilditch CA, Tsang ACO, et al. Venous sinus stenting for idiopathic intracranial hypertension: systematic review and meta analysis. J Neurointerv Surg. 2019;11(4):380–5. DOI: 10.1136/neurintsurg-2018-014172
Authors
Copyright (c) 2025 Izza Ayudia Hakim, Bagus Dermawan, Yingying Zhang, Guangzheng Zhang

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.