The Effect of Vertebral Venous Collaterals on Intracranial Hypertension and Related Symptoms in Patients with Bilateral Transverse Sinus Stenosis

Abstract

Background: Vertebral venous collaterals (VVC) were often found in patients with bilateral transverse sinus stenosis (BTSS). The purpose of this study was to investigate the physiological role of VVC in BTSS patients.Methods: The index of TSS was used in the assessment of BTSS severity. Subjects underwent a standard lumbar puncture to measure the intracranial pressure (ICP). Papilledema and tinnitus were evaluated by using Frisén's grade and questionnaires for tinnitus handicap inventory (THI), respectively. The intensity and impact of headache was assessed by using 10-point Numeric Pain Rating Scale (NPRS) and six-item Headache Impact Test (HIT-6).Results: BTSS group had more patients with severe intracranial hypertension (IH) and less patients with normal ICP. BTSS patients had higher ICP than normal controls. Further analysis on VVC showed that VVC decreased the elevated ICP in BTSS patients and exerted no impact on ICP in normal controls. A similar incidence of VVC in BTSS patients and normal controls were found. BTSS patients with normal ICP and mild IH exhibited a higher incidence of VVC compared with those with severe IH. VVC, rather than the severity of BTSS, regulated the ICP. Furthermore, VVC alleviated IH-related clinical manifestations including papilledema and tinnitus in BTSS patients.Conclusions: The present study demonstrated BTSS is correlated with IH. The presence of VVC, which is postulated to be congenitally formed, normalizes the elevated ICP and alleviated IH-related symptoms in BTSS patients. VVC may be used as an indicator of relatively low ICP in BTSS patients.Trial registration: This study was registered retrospectively on 07/28/2020 (NCT04492332).