Symptomatic transverse sinus stenosis. Clinical and angiographic classification and endovascular therapy: A case series

Background: Transverse sinus stenosis is a treatable cause of idiopathic intracranial hypertension syndrome and intolerable pulsatile tinnitus syndrome. However, it is often underdiagnosed and left untreated. Stenting at the level of stenosis has emerged as an alternative therapy. This paper presents a clinical and angiographic classification, the technical outcome of the procedure, and the clinical and angiographic follow-up. Methods: We present a case series of idiopathic intracranial hypertension syndrome and intolerable pulsatile tinnitus due to transverse sinus stenosis treated with endovascular angioplasty. We included patients with a pressure gradient ≥ 8 mm Hg across the transverse sinus stenosis with a minimum clinical and angiographic follow-up of 18 months. Results: Twenty-four patients were eligible for this study and were classified into four clinical categories and two angiographic types. Twelve patients had a history of migraine with different clinical types for several years. All patients had satisfactory angioplasty with a single stent (Wallstent®) and complete resolution of idiopathic intracranial hypertension syndrome and intolerable tinnitus. Only one patient presented a complication (subdural hematoma) and required surgery. Twenty-two patients had an angiographic control five and ten months after angioplasty, showing a stable stent, with no stenosis, and with patent Labbé vein. Conclusion: This case series reports excellent technical and clinical outcomes in all patients with idiopathic intracranial hypertension syndrome and intolerable pulsatile tinnitus due to transverse sinus stenosis treated with endovascular angioplasty. We propose a clinical and angiographic classification that will contribute to optimizing diagnosis and therapeutic decision-making processes.