Transverse venous sinus stenosis – a risk factor for CSF leak in patients with idiopathic intracranial hypertension
Reviewed by Richard (Wei Chern) Gan

This was a multicentre (six French tertiary hospitals) retrospective case-controlled study aiming to investigate the rate of transverse venous sinus stenosis (TVSS) in patients with idiopathic intracranial hypertension (IIH) with nasal cerebrospinal fluid (CSF) leaks. They compared the preoperative MRI of patients with IIH who had undergone endoscopic transnasal CSF leak repair with the MRI images of patients with IIH without CSF leak (control). MRI characteristics suggestive of IIH were also compared. A total of 32 patients (72% female) were included in the spontaneous CSF leak with IIH group, compared to 32 patients with IIH without CSF leak. Patients were controlled for sex. CSF leak site was the ethmoid region in 62.5%, sphenoid 34.4% and frontal 3.1%. Mean age was 50±13.01 years in the CSF leak group compared to 31±6.89 years in the control group. Stenosis of at least one transverse sinus was found in significantly more of those with spontaneous nasal CSF leak (84.4%) compared to controls (56.2%; p=0.029). Comparing the groups for MRI IIH characteristics, arachnoid granulations were also a risk factor for nasal CSF leak. They conclude that TVSS is an independent risk factor for CSF leak in patients with IIH. With this in mind, they propose that techniques for TVSS management could be considered preoperatively to reduce the need for surgery or postoperatively to increase surgical success.

Transverse Venous Sinus Stenosis in Patients with Nasal Cerebrospinal Fluid Leak and Idiopathic Intracranial Hypertension.
Hurel C, Favier V, Bonnecaze G, et al.
OTOLARYNGOL HEAD NECK SURG
2023;169(6):1647–53.