VSS for patients with IIH with venous sinus stenosis is now an established and effective treatment option. These recommendations have been provided, based on a summative review of the available published literature, to assist in standardizing care for patients with IIH undergoing VSS.

The degree of stenosis predictive of a clinically significant pressure gradient (30-35%) in the venous sinuses is considerably lower than the arterial stenosis at which pathologic hemodynamic alterations occur. While highly predictive of a venous pressure gradient when a stenosis is identified, non-invasive imaging does not appear to be a suitable diagnostic evaluation for the purpose of ruling out clinically significant cerebral VSS.

BackgroundThe toll of burnout on healthcare is significant and associated with physician depression and medical errors.ObjectiveTo assess the prevalence and risk factors for burnout among neurointerventionalists.MethodsA 39-question online survey containing questions about neurointerventional practice and the Maslach Burnout Inventory-Human Services Survey for medical personnel was distributed to members of major US neurointerventional physician societies.Results320 responses were received. Median (interquartile range) composite scores for emotional exhaustion were 25 (16–35), depersonalization 7 (4–12), and personal accomplishment 39 (35–44). 164/293 respondents (56%) met established criteria for burnout. There was no significant relationship between training background, practice setting, call frequency, or presence of a senior partner on burnout prevalence. Multiple logistic regression analysis showed that feeling underappreciated by hospital leadership (OR=3.71; p<0.001) and covering more than one hospital on call (OR=1.96; p=0.01) were strongly associated with burnout. Receiving additional compensation for a call was independently protective against burnout (OR= 0.70; p=0.005).ConclusionsThis survey of United States neurointerventional physicians demonstrated a self-reported burnout prevalence of 56%, which is similar to the national average among physicians across other specialties. Additional compensation for a call was a significant protective factor against burnout. In addition, feeling underappreciated by departmental or hospital leadership and covering more than one hospital while on call were associated with greater odds of burnout.

ObjectiveTo determine the relationship between normal physiologic and pathologic venous sinus pressures in patients with idiopathic intracranial hypertension (IIH), which is poorly understood.MethodsRetrospective analysis was performed to identify patients with medically refractory IIH who were evaluated by angiography and retrograde venography with venous manometry. Patients were further subdivided into groups based on anatomic factors.Results104 patients met inclusion criteria for the study. In the absence of non-invasive venographic screening, 58% of patients in this series were found to have pressure gradients of ≥8 mm Hg; 93% were located near the transverse-sigmoid sinus junction. Opening pressure (OP) is strongly predictive of superior sagittal sinus (SSS) pressures (p<0.001) and also of the presence of a pressure gradient ≥8 mm Hg (p<0.001). Twenty-three percent of patients with an OP <25 had a pressure gradient ≥8 mm Hg compared with 77% of patients with an OP ≥35. Analysis of patients with OP ≤20 suggests that SSS pressures in patients without IIH should be less than 16–18 mm Hg with total cranial gradients <5 mm Hg. Across all patients, a pressure decrement of approximately 1 mm Hg occurs with progressively more caudal transition across anatomic points of measurement.ConclusionsThis study describes intracranial and extracranial venous pressure measurements and gradients in different subgroups of patients with IIH. OP is highly predictive of intracranial venous pressures and significant venous pressure gradients.

There has been an increasing focus on academic productivity for the purposes of promotion and funding within departments and institutions but also for comparison of individuals, institutions, specialties, and journals. A number of quantitative indices are used to investigate and compare academic productivity. These include various calculations attempting to analyze the number and citations of publications in order to capture both the quality and quantity of publications, such as the h index, the e index, impact factor, and Eigenfactor score. The indices have varying advantages and limitations and thus a basic knowledge is required in order to understand their potential utility within academic medicine. This article describes the various bibliometric indices and discusses recent applications of these metrics within the neurological sciences.

BackgroundLong term failure rates after venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) are poorly understood.MethodsRetrospective analysis was performed on a prospectively-maintained single center database to identify patients with medically refractory IIH who underwent VSS. Patients with persistent or severe recurrent symptoms after VSS undergo lumbar puncture (LP), therefore LP serves as a marker for treatment failure.Results81 patients underwent VSS with a mean follow-up of 10 months; 44 (54.3%) patients underwent LP after VSS due to persistent or recurrent symptoms at a mean of 12 months (median 7, range 2–43). There was a mean decrease in opening pressure (OP) on LP from pre- to post-VSS of 9.1 cm H2O (median 9.5). Overall, a total of 21 (25.9%) patients underwent further surgical intervention following VSS, including five who underwent repeat VSS (6.2% of total) and 18 who underwent cerebrospinal fluid shunting (22.2% of total). There was a non-significant (p=0.18) but overall increase in quality of life scores from pre-stenting (61.2) to last follow-up (71.2), and a significant decrease in Headache Impact Test-6 (HIT-6) scores (p=0.03) with mean pre-stenting and last follow-up scores of 62.7 and 55.8, respectively.ConclusionsVSS is an effective treatment for venous sinus stenosis in IIH; however, this study found higher rates of symptomatic recurrence and need for further surgical intervention (26%) than previously reported in the literature. Recurrence of symptoms occurred at a median of 7 months, even though OP remained lower at follow-up LP, suggestive of a re-equilibration phenomenon.

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The cerebral venous waveform appears to be influenced by both the ICP and CVP waveforms. As measurement moves proximally, the waveform progressively changes to mirror the CVP waveform. Venous sinus stenosis results in a high amplitude waveform which improves with treatment of the stenosis.