Dynamic intraoperative changes in intracranial pressure during venous stenting

This presentation reports a case of a middle-aged female with idiopathic intracranial hypertension (IIH) manifesting as progressive vision loss and papilledema due to bilateral transverse sinus stenosis. Initial management with acetazolamide yielded transient improvement; however, recurrent symptoms prompted further evaluation. Preoperative imaging confirmed significant stenosis and elevated intracranial pressure (ICP), leading to a treatment plan incorporating lumbar drainage and venous stenting.1 Intraoperative dynamic ICP monitoring was performed throughout balloon angioplasty and stent deployment in the left transverse/sigmoid sinus (video 1). Despite technical challenges from severe venous tortuosity and limited access, strategic multi-access planning and the use of optimized balloon angioplasty and stent systems enabled successful intervention and post-dilation, resulting in improved ICP. Our findings emphasize the critical role of dynamic ICP monitoring in guiding venous stenting procedures for IIH and demonstrate the potential to refine treatment strategies for complex venous sinus stenoses, ultimately contributing to better clinical outcomes. neurintsurg;17/8/793/V1F1V1Video 1 Operative video demonstrating venous sinus stenting with concurrent ICP measurement.